ARCHIVEOBSTETRICS AND GYNECOLOGY
International Medical Journal, Vol. 23., Iss. 4, 2017, P. 42−46.
ESTIMATION OF THE EFFECTIVENESS OF EXTRACORPOREAL FERTILIZATION AFTER TRANSFER OF VITRIFIED BLASTOCYSTS IN THE NATURAL CYCLE AND WITH THE USE OF HORMONE REPLACEMENT THERAPY
Kharkiv National Medical University, Ukraine
At present the most effective method of infertility treatment is extracorporeal fertilization. To increase the treatment effectiveness it is important to achieve the transfer of the best quality embryo during the greatest endometrial susceptibility to implantation. In this regard, support of the luteal phase (LPh) should become an integral component of IVF programs. The aim of this work was to study the effectiveness of IVF after the transfer of vitrified blastocysts in a modified natural cycle and with the use of hormone replacement therapy (HRT). The study included 173 patients of the main group, which were performed in vitro fertilization due to infertility of various origin. Group 1 comprised 51 patients with transfer of vitrified embryos to the natural menstrual cycle (MC). All observed women were monitored the growth of follicles using ultrasonography. All the patients were performed ultrasound monitoring of the follicle growth. Transvaginal ultrasound was performed using V−K Medical device. Five days after the ovulation the embryos were transferred to the uterus. Given the presence of a yellow body in the ovary at the time of ovulation, support for the second phase of the MC was not carried out. Group 2 included 92 women, who were prescribed gonadotropin−releasing hormone agonist at a dose of 0.05 mg subcutaneously daily 10 days before menstruation. Endometrium preparation was carried out with estrogens (estradiol valerate 6 mg daily). When the thickness of the endometrium reached 8 mm, gonadotropin−releasing hormone agonist was discontinued. Two days later, to support the luteal phase, 90 mg progesterone gel was administered intravaginally bid 14 days. Group 3 included the patients with a modified natural menstrual cycle, who had not undergone embryo transfer before because of a high risk of severe hyperstimulation. In this group of patients, all embryos obtained were vitrified (Freeze−all). Heated embryos were transferred to the uterus on the 5th day after the ovulation onset. Support for the luteal phase in this group of women was carried out by daily intravaginal administration of 90 mg progesterone gel for 2 weeks. The obtained findings confirm that after the transfer of embryos into the uterine cavity during the first 2 weeks, the woman's organism reacts to the support of the luteal phase differently, however, even in the absence of HRT, restores the hormonal potential, tuned for implantation and further embryo development. The most effective is the IVF protocol, in which the transfer of verified blastocysts occurs in a modified natural MC with LPH support by daily intravaginal 90 mg progesterone gel administration for 2 weeks. Progesterone, administered vaginally, directly affects the uterus and endometrium and within a few hours the level of this hormone in the blood increases. The main reason for the negative effect of high levels of progesterone administered on the efficacy of IVF is the phenomenon of premature transformation of the endometrium. Failure to transfer fresh embryos in stimulated menstrual cycles gives a high opportunity for pregnancy after transfer of vitrified blastocysts in a modified natural MC without a risk to the patient's health.
Key words: extracorporeal fertilization, hormone replacement therapy, luteal phase support, vitrified blastocysts.