Different ART outcomes at increasing peak estradiol levels with long and antagonist protocols: retrospective insights from ten years experience.

PURPOSE: To evaluate the impact of high estradiol (E2) levels on assisted reproductive technologies outcomes in high responders (≥12 oocytes retrieved) according to the controlled ovarian stimulation protocol (COS) used. METHODS: Clinical retrospective evaluation of total, clinical pregnancy and implantation rates in ART cycles performed in high responders according to the COS protocol used (long or antagonist) at Pathophysiology Unit of Human Reproduction and Sperm Bank of Pordenone from June 2000 to December 2010. RESULTS: In high responders total, clinical and implantation rates were significantly higher in long if compared with antagonist protocol with peak estradiol level ≤3,000 pg/ml; on the contrary there was a significantly higher implantation rate with antagonist than long protocol with peak estradiol >3,000 pg/ml. However in this subgroup of patients total and clinical pregnancy rates showed only a trend favouring antagonist possibly due to a statistical ß error. CONCLUSIONS: In high responders long protocol seems to work better than antagonist when peak E2 is lower than 3,000 pg/ml but the opposite may be true for cycles with higher E2 levels.

Greater implantation and pregnancy rates with vaginal progesterone in intracytoplasmic sperm injection but not in in vitro fertilization cycles: a retrospective study.

OBJECTIVE: To compare the effectiveness of vaginal progesterone supplementation with intramuscular supplementation in assisted reproduction cycles. DESIGN: Retrospective study. SETTING: Physiopathology of Human Reproduction Unit, Pordenone, Italy, from July 2000 to June 2004. PATIENT(S): Three hundred and eight-five intracytoplasmic sperm injection (ICSI) procedures (188 with vaginal gel and 197 with intramuscular progesterone) and 373 in vitro fertilization (IVF) cycles (227 with vaginal and 146 with intramuscular progesterone). INTERVENTION(S): Progesterone luteal supplementation: vaginal gel (Crinone 8% 90 mg/day) or intramuscular (Prontogest 50 mg/day). MAIN OUTCOME MEASURE(S): Implantation rates, and total and clinical pregnancy rates. RESULT(S): Higher rates of implantation and total and clinical pregnancies were observed in the vaginal supplemented ICSI subgroup than in the intramuscular one. This difference was observed for all transfers (13.3% vs. 8.8%, 39.8% vs. 23.3%, and 28.7% vs. 18.6%) and for ultrasound-guided transfers (17.2% vs. 9.3%, 49% vs. 27%, and 36.9% vs. 21.1%, respectively). CONCLUSION(S): The vaginal route of luteal supplementation may be better than the intramuscular one, yielding higher implantation rates as well as total and clinical pregnancy rates in ICSI cycles but not in classic IVF treatments.