The Effects Of Estradiol Addition With Progesterone As Luteal Phase Support In IVF Cycles

Objective:To explore the effects of estradiol addition with progesterone as luteal phase support on the clinical pregnancy outcomes of women undergoing in vitro fertilization-embryo transfer(IVF-ET)cycles.Methods:We conducted a retrospective cohort study of patients(Group P+E,N=2115)taking luteal phase support with progesterone and estradiol compared with patients(Group E,N=4230)taking luteal phase support with progesterone only,in Women’s Hospital,School of Medicine,Zhejiang University between January 2010 to January 2015,after matching for age,body mass index,endometrial thickness on embryo transferred day and number of embryos transferred.(1)Through univariate and logistic regression analysis,we compared the pregnancy outcomes between Group P+E and Group E,and discussed the key factors influencing the outcomes.(2)Further,subgroups were stratified by triggering day estrogen levels,to compare the effects of estradiol addition with progesterone on pregnancy outcomes at different estrogen peak levels.(3)Patients in this study who gave single birth in our hospital were divided into two groups according to whether estrogen was added in the luteal phase support,and the differences of pregnancy complications and perinatal complications incidence were compared between the two groups.Results:(1)A total of 6345 cycles from 6345 patients were included in the analysis,of which 4230 patients had luteal phase support with only progesterone and 2115 patients had luteal phase support with progesterone plus estradiol.Estradiol addition to progesterone was not an independent factor affecting clinical pregnancy(OR = 0.899,95%Cl:0.802～1.008),but was the independent impact factor affecting premature birth(OR=1.379,95%CI:1.078～1.764).(2)Progesterone plus estradiol was a risk factor for preterm birth in patients with triggering day estrogen level between 5000-10000 pmol/L(OR = 1.436,95%CI:1.028～2.008).(3)For patients with single births,whose estrogen level was in the range of 5000-10000 pmol/L on triggering day,the incidence of placenta previa and gestational hypertension were higher in estradiol addition with progesterone group compared with progesterone group,but there was no statistically significant difference(P>0.05).Conclusion:The estradiol addition with progesterone luteal phase support does not significantly improve the clinical pregnancy rate,but increase the risk of preterm birth in patients with estrogen level between 5000-10000 pmol/L on triggering day.For patients with single birth,estradiol addition in luteal phase support did not seem to significantly increase or decrease the incidence of pregnancy complications and perinatal complications.