Low serum progesterone the day prior to frozen embryo transfer of euploid embryos is associated with significant reduction in live birth rates

Abstract

A retrospective cohort study was performed to examine whether, in artificial endometrial preparation for frozen embryo transfer (FET) cycles, progesterone (P) levels the day prior to embryo transfer of euploid embryos have an impact on pregnancy outcomes. In a private university clinic, 244 FETs between January 2016 and June 2017 were analyzed. Endometrial preparation was achieved with estradiol valerate and vaginal micronized progesterone. Serum P and estradiol levels the day prior to embryo transfer were measured. A multivariable analysis to assess the relationship between serum P level and pregnancy outcomes was performed, adjusted for confounding variables. Mean P value was 11.3?±?5.1?ng/ml. Progesterone levels were split in quartiles: Q1: ≤ 8.06?ng/ml; Q2: 8.07–10.64?ng/ml; Q3: 10.65–13.13?ng/ml; Q4: > 13.13?ng/ml. Patients included in the lower P quartile had a significantly higher miscarriage rate and significantly lower live birth rate (LBR) compared to the higher ones. A low serum P level (≤ 10.64?ng/ml) one day before FET is associated with a lower pregnancy and LBR following FET of euploid embryos.     

孕激素类药物对妊娠期糖尿病的影响

孕激素类药物在临床应用非常广泛，非妊娠期可用于避孕、治疗子宫内膜异位症、调理月经等妇科疾病，妊娠期使用主要用于黄体支持治疗、预防和治疗先兆流产以及预防和治疗早产。孕激素在我国应用于孕早期保胎非常普遍且呈滥用趋势，近年有研究发现孕激素在孕期的使用可能导致妊娠期糖尿病的发生。本文从孕激素的分类、孕激素在妊娠期的使用与妊娠期糖尿病的相关性及孕激素导致妊娠期糖尿病发生的可能机制等方面对孕激素在妊娠期的使用对妊娠期糖尿病的影响做一综述，为临床在妊娠期合理使用孕激素类药物提供参考。     

Evaluation of NMU-Induced Breast Cancer Treated with Sirolimus and Sunitinib on Breast Cancer Growth

Objective: To analyze the effect of sirolimus and sunitinib in blocking the tumor growth and to evaluate the expressions of estrogen receptor (ER), progesterone receptor (PgR), and human epidermal growth factor receptor-2 (HER2/neu) after treated with sirolimus and sunitinib. Methods: Thirty-two female Sprague Dawley rats at age 21-days old were administered intraperitoneally with N-Methyl-N-Nitroso Urea (NMU), dosed at 70mg/kg body weight. The rats were divided into 4 groups; Group 1 (Control, n=8), Group 2 (Sirolimus, n=8), Group 3 (Sunitinib, n=8) and Group 4 (Sirolimus+Sunitinib, n=8), being treated twice when the tumor reached the size of 14.5±0.5 mm and subsequently sacrificed after 5 days. The protein expressions of ER, PgR and HER2/neu of the tumor tissues were evaluated by using immunohistochemistry analysis. Results: Treatment with sirolimus alone lowered expressions of ER and PgR of breast cancer and reduced tumor size. There was no significant difference of ER and PgR expressions between control and sunitinib treated tumor. Sunitinib treated tumors reduce in diameter after the first treatment, however the diameter increases after the second treatment. Histologically, sunitinib treated tumor did not show any aggressive invasive carcinoma of no special type (NST) histological subtypes. In addition, all NMU-induced tumors are HER2/neu-negative scoring. Conclusion: Sirolimus is neither synergistic nor additive with sunitinib for breast cancer treatment.     

Uso de la anticoncepción con solo gestágenos en atención primaria: estudio GESTAGAP

AimTo estimate the prevalence of use of progestin-only contraceptive among women who request reversible contraception in Primary Care (PC).DesignMulticentre cross-sectional study.SettingPrimary Care Health Care Centres (Madrid).ParticipantsWomen aged 16-50 years old, users of reversible contraception, who speak Spanish, and had attended the Primary Care Centre in the last year.Main measurementsPrimary outcome: contraceptive method used: Contraception with progestins-only (yes/no). Age, parity, country of origin, type of contraceptive method used, reason for choice, source of information, satisfaction with the contraceptive method. Telephone survey.ResultsA total of 417 women were interviewed. The median age was 30.3 years (SD: 7.7). Spanish 69%, and 82% of participants had secondary or university studies. More than half (57%) were nulliparous. The type of contraceptive used included: progestins only: 14%, combined hormonal contraceptive: 74%, copper IUD: 2%, and condom 10%. The prevalence of use of “progestins-only” was 13.9% (95% CI: 10.6-17.2). Medroxyprogesterone acetate injection was the most progestin-only method used (4.6%), desogestrel oral pill (4.1%), IUD-levonorgestrel IUD (3.9%), and etonogestrel subdermal implant (1.9%). The family doctor was the prescriber in 71% of the women. Satisfaction: high (range 9-10). Using only progestogens was associated with older age, being non-Spanish, breastfeeding, and having a medical contraindication for combined contraception (P < 0.05).ConclusionsThe prevalence of use for progestins was 14%, satisfaction was very high for all contraceptive methods. The user profile for the only progestins-only corresponds to older, and non-Spanish women with conditions such as breastfeeding or contraindications for other contraceptives.     

Progesterone use in assisted reproductive technology

Progesterone is the main hormone in the luteal phase. It plays a key role in preparing the uterus for a possible pregnancy, and in maintaining it after it has occurred. In assisted reproduction treatments, there is usually a luteal phase deficiency, so it is necessary to supplement this critical phase to obtain the best results, not only of implantation but also of ongoing pregnancy. Among all the available options, exogenously administered progestogens are the most used, as they have proven their efficacy and safety. This review will address the most relevant aspects of luteal phase support with progesterone in the different scenarios an embryo transfer can be performed, such as the stimulated cycle, the artificial cycle, or the natural cycle. Although there is no evidence of the perfect protocol for all patients, recent studies point to the need of individualizing luteal phase support according to the needs of each patient.