Comparison of vaginal versus intramuscular progesterone in programmed cycles for frozen-thawed blastocyst transfer in patients with endometriosis
Abstract Background Previous studies have shown that due to the presence of endometrium progesterone resistance in patients with endometriosis, it is considered that higher levels of progesterone may be required to achieve live birth during programmed frozen-thawed embryo transfer (FET) cycles. Curr...
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BMC
2025-02-01
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| Series: | Reproductive Biology and Endocrinology |
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| Online Access: | https://doi.org/10.1186/s12958-025-01354-7 |
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| author | Ziqi Jin Guoxia Yang Tianrui Wen Benyu Miao Chen Wang Qingyan Zhang Fang Gu Yanwen Xu |
| author_facet | Ziqi Jin Guoxia Yang Tianrui Wen Benyu Miao Chen Wang Qingyan Zhang Fang Gu Yanwen Xu |
| author_sort | Ziqi Jin |
| collection | DOAJ |
| description | Abstract Background Previous studies have shown that due to the presence of endometrium progesterone resistance in patients with endometriosis, it is considered that higher levels of progesterone may be required to achieve live birth during programmed frozen-thawed embryo transfer (FET) cycles. Currently, the optimal progesterone support in FET cycles remains a contentious issue, and it mainly focused on the general infertile population, without specific attention to infertile patients with endometriosis. This study aimed to compare the pregnancy outcomes between vaginal or intramuscular progesterone administration in patients with endometriosis, and to determine whether the stage of endometriosis moderates the differences. Methods This retrospective cohort study included patients with endometriosis who underwent their first single frozen-thawed blastocyst transfer in a programmed cycle from January 2018 to April 2024 at a university-affiliated reproductive medical center. According to the routes of luteal support, patients were divided into vaginal progesterone and intramuscular progesterone groups. Analyses were conducted using multivariate regression models and subgroup analysis. Interaction tests were employed to determine whether the revised American Society for Reproductive Medicine (r-ASRM) stages of endometriosis moderated the differences between the routes of progesterone administration and pregnancy outcomes. Results A total of 825 programmed frozen-thawed blastocyst transfer cycles were included in the analysis, with 362 cases using vaginal progesterone and 463 cases using intramuscular progesterone. In the overall cohort, clinical pregnancy rate of the vaginal progesterone group was 49.17%, comparable to 44.06% of the intramuscular progesterone group (aOR 0.82, 95% CI 0.61–1.11). Similarly, there was no statistically significant difference in miscarriage rates between the two groups (16.85% versus 24.51%; aOR 1.57, 95% CI 0.90–2.75). In the subgroup analysis in patients classified as r-ASRM stages I-II, clinical pregnancy rate of vaginal progesterone group was significantly higher than that of intramuscular group (aOR 0.74, 95% CI 0.58–0.93, P = 0.011). Whereas, in patients with stages III-IV, no significant differences in pregnancy outcomes between the two groups were detected. Interaction tests between the routes of progesterone administration and r-ASRM stages were significant (P = 0.036). Conclusions In the first single frozen-thawed blastocyst transfer cycles for endometriosis patients with r-ASRM stages I-II, vaginal progesterone favours a higher clinical pregnancy rate compared to the intramuscular progesterone. |
| format | Article |
| id | doaj-art-e373891009d44570955c429c39b0cb39 |
| institution | Kabale University |
| issn | 1477-7827 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | BMC |
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| series | Reproductive Biology and Endocrinology |
| spelling | doaj-art-e373891009d44570955c429c39b0cb392025-02-09T13:00:04ZengBMCReproductive Biology and Endocrinology1477-78272025-02-0123111110.1186/s12958-025-01354-7Comparison of vaginal versus intramuscular progesterone in programmed cycles for frozen-thawed blastocyst transfer in patients with endometriosisZiqi Jin0Guoxia Yang1Tianrui Wen2Benyu Miao3Chen Wang4Qingyan Zhang5Fang Gu6Yanwen Xu7Reproductive Medicine Center, The First Affiliated Hospital of Sun Yat-Sen UniversityReproductive Medicine Center, The First Affiliated Hospital of Sun Yat-Sen UniversityReproductive Medicine Center, The First Affiliated Hospital of Sun Yat-Sen UniversityReproductive Medicine Center, The First Affiliated Hospital of Sun Yat-Sen UniversityReproductive Medicine Center, The First Affiliated Hospital of Sun Yat-Sen UniversityReproductive Medicine Center, The First Affiliated Hospital of Sun Yat-Sen UniversityReproductive Medicine Center, The First Affiliated Hospital of Sun Yat-Sen UniversityReproductive Medicine Center, The First Affiliated Hospital of Sun Yat-Sen UniversityAbstract Background Previous studies have shown that due to the presence of endometrium progesterone resistance in patients with endometriosis, it is considered that higher levels of progesterone may be required to achieve live birth during programmed frozen-thawed embryo transfer (FET) cycles. Currently, the optimal progesterone support in FET cycles remains a contentious issue, and it mainly focused on the general infertile population, without specific attention to infertile patients with endometriosis. This study aimed to compare the pregnancy outcomes between vaginal or intramuscular progesterone administration in patients with endometriosis, and to determine whether the stage of endometriosis moderates the differences. Methods This retrospective cohort study included patients with endometriosis who underwent their first single frozen-thawed blastocyst transfer in a programmed cycle from January 2018 to April 2024 at a university-affiliated reproductive medical center. According to the routes of luteal support, patients were divided into vaginal progesterone and intramuscular progesterone groups. Analyses were conducted using multivariate regression models and subgroup analysis. Interaction tests were employed to determine whether the revised American Society for Reproductive Medicine (r-ASRM) stages of endometriosis moderated the differences between the routes of progesterone administration and pregnancy outcomes. Results A total of 825 programmed frozen-thawed blastocyst transfer cycles were included in the analysis, with 362 cases using vaginal progesterone and 463 cases using intramuscular progesterone. In the overall cohort, clinical pregnancy rate of the vaginal progesterone group was 49.17%, comparable to 44.06% of the intramuscular progesterone group (aOR 0.82, 95% CI 0.61–1.11). Similarly, there was no statistically significant difference in miscarriage rates between the two groups (16.85% versus 24.51%; aOR 1.57, 95% CI 0.90–2.75). In the subgroup analysis in patients classified as r-ASRM stages I-II, clinical pregnancy rate of vaginal progesterone group was significantly higher than that of intramuscular group (aOR 0.74, 95% CI 0.58–0.93, P = 0.011). Whereas, in patients with stages III-IV, no significant differences in pregnancy outcomes between the two groups were detected. Interaction tests between the routes of progesterone administration and r-ASRM stages were significant (P = 0.036). Conclusions In the first single frozen-thawed blastocyst transfer cycles for endometriosis patients with r-ASRM stages I-II, vaginal progesterone favours a higher clinical pregnancy rate compared to the intramuscular progesterone.https://doi.org/10.1186/s12958-025-01354-7Endometriosisr-ASRMVaginal progesteroneIntramuscular progesteroneClinical pregnancy |
| spellingShingle | Ziqi Jin Guoxia Yang Tianrui Wen Benyu Miao Chen Wang Qingyan Zhang Fang Gu Yanwen Xu Comparison of vaginal versus intramuscular progesterone in programmed cycles for frozen-thawed blastocyst transfer in patients with endometriosis Reproductive Biology and Endocrinology Endometriosis r-ASRM Vaginal progesterone Intramuscular progesterone Clinical pregnancy |
| title | Comparison of vaginal versus intramuscular progesterone in programmed cycles for frozen-thawed blastocyst transfer in patients with endometriosis |
| title_full | Comparison of vaginal versus intramuscular progesterone in programmed cycles for frozen-thawed blastocyst transfer in patients with endometriosis |
| title_fullStr | Comparison of vaginal versus intramuscular progesterone in programmed cycles for frozen-thawed blastocyst transfer in patients with endometriosis |
| title_full_unstemmed | Comparison of vaginal versus intramuscular progesterone in programmed cycles for frozen-thawed blastocyst transfer in patients with endometriosis |
| title_short | Comparison of vaginal versus intramuscular progesterone in programmed cycles for frozen-thawed blastocyst transfer in patients with endometriosis |
| title_sort | comparison of vaginal versus intramuscular progesterone in programmed cycles for frozen thawed blastocyst transfer in patients with endometriosis |
| topic | Endometriosis r-ASRM Vaginal progesterone Intramuscular progesterone Clinical pregnancy |
| url | https://doi.org/10.1186/s12958-025-01354-7 |
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