The Effect of Periovulatory Progesterone Supplementation in In Vitro Fertilization and Embryo Transfer Program / 대한산부인과학회잡지

ABSTRACT

OBJECTIVE: The purpose of this study was to investigate whether high dose progesterone intramuscular injections before oocyte retrieval and thereafter increase the implantation and pregnancy rates through improvement of uterine receptivity in patients undergoing in vitro fertilization-embryo transfer (IVF-ET). METHODS: The retrospective randomized analysis was performed in whom undergoing conventional IVF- ET at Chonnam National University Hospital Infertility Clinic from August, 1996 to July, 2001. The study group consisted of 57 patients having intramuscular progesterone injections for 4-5 days from the day of hCG injection to the day of embryo transfer and 60 patients without progesterone supplement (control group). We compared between two groups with respect to age distribution, cause of infertility, blood levels of hormone, number of aspirated ovum, number of fertilized egg, number of cleaved embryo, number of transfered embryo, embryo transplantation, cumulative embryo score, chemical and clinical pregnancy rates. RESULTS: The oocytes retrievals were done at 87 cycles in study group and 82 cycles in control group. There were no significant differences in the average age and distribution of causes of infertility. Tubal factor was the dominant cause of infertility in both groups. There were no significant differences in the number of aspirated eggs, number of fertilized eggs, cleavage rates and number of multinuclear fertilized eggs. The embryo transfer were performed 76 out of 87 cycles in study group, and 64 out of 82 cycles in control group. The average number of transferred embryos to the uterine cavity was not different, in the study and control group (2.72+/-1.64 and 2.39+/-2.03 respectively). The chemical pregnancy rate did not differ significantly (7.89% in study group, and 6.25% in control group). The clinical pregnancy rate was higher in the control group (18.75%) than in the study group (12.84%), but the result was not statistically significant. However, the number of fertilized eggs and cumulative embryo score were significantly higher in study group. CONCLUSION: High dose of progesterone supplementation before and after oocyte retrieval in IVF-ET cycles did not improve pregnancy outcome, instead showed lower pregnancy rate than no supplement group, thus we cannot consider progesterone supplementation improve endometrial receptivity and increase implantation and pregnancy rate. But, since we could improve the fertilization rate and embryo development rate through increase of the number of fertilized eggs and cumulative embryo score, further evaluation is needed in this field and we have to make vigorous efforts to increase implantation rate in IVF-ET cycles.