A comparison of the effects of three luteal phase support protocols with estrogen on in vitro fertilization-embryo transfer outcomes in patients on a GnRH antagonist protocol

OBJECTIVE: This study aimed to evaluate the effects of three different luteal phase support protocols with estrogen on the pregnancy rates and luteal phase hormone profiles of patients undergoing in vitro fertilization-embryo transfer (IVF-ET) cycles. A secondary objective was to evaluate which ovarian reserve markers correlated with pregnancy rates. METHODS: This retrospective observational study was carried out at a private tertiary reproductive medicine teaching and research center. The study enrolled 104 patients undergoing intracytoplasmic sperm injection (ICSI) on an antagonist protocol for controlled ovarian hyperstimulation (COH). The women were divided into three groups based on the route of administration of estrogen (E2) for luteal phase support: oral (Primogyna); transdermal patches (Estradott); or transdermal gel (Oestrogel Pump). The administration of estrogen provided the equivalent to 4 mg of estradiol daily. All women received 600mg of vaginal progesterone (P) per day (Utrogestan) for luteal phase support. Blood samples were drawn on the day of hCG administration and on the day of beta hCG testing to measure E2 and P levels. Clinical pregnancy rate (PR) was the main endpoint. RESULTS: The patients included in the three groups were comparable. No significant differences were found in implantation rates, clinical PR, miscarriage rates, multiple-pregnancy rates, E2 or P levels on the day of beta hCG measurement. Concerning ovarian reserve markers, significant correlations between testing positive for clinical pregnancy and AMH (r = 0.66, p<0.0001) and E2 levels on beta hCG measurement day (r = 0.77; p<.0001) were observed. CONCLUSIONS: No significant differences were seen in the pregnancy rates of patients submitted to IVF-ET cycles with GnRH antagonists given oral, transdermal patches, or transdermal gel E2 during the luteal phase. A correlation was found between clinical pregnancy rate and AMH and E2 levels on beta hCG testing day.