How can you give estrogen in a frozen embryo replacement ? Can we give estrogen longer ?
I’m dr. emil quarry i’m all the consultants in reproductive medicine surgery in assisted conception other hominid fertility center once again i bring today an observational study which will answer some of our questions on frozen egg replacement cycles often be aroused in a medicated cycle now let’s go back to the three word ways you can do a frozen replacement
Cycle number one is you can down regulate and then you can add distortion so it’s a down regulated and a medicated cycle second you take away two down regulation and you give it only a medicated cycle this extrusion reparation and the third is natural or modification of lines will interview of stimulated all these three go to a different discussion and there are
Much longer discussion to follow so let us go back and answer this question is how long should be sturgeon therapy be and does prolonged estrogen treatment for the frozen embryo replacement cycle reduce success rates now this paper was published in 2018 in human reproduction and it looked towards answering that question prolonged estrogen treatment prior to frozen
Blastocyst transfer decreases the live birth rate next what was looked at it was an observational cohort study july 2012 to december 2015 ivf or exceed less than 42 years a single blastocyst transfer and artificial and the material preparation and the groups were divided according to the number of days estrogen was and the mental preparation was either through
Patches that is 0.2 milligram per day or a transdermal or was on oral four milligram twice a day today before starting the progesterone measured measurements were done and he in the met room was assessed at the endometrial less than six millimeter all this saw a high progesterone level rise to 1.5 nanogram per ml the transfer was cancelled so what they are looking
Towards is tell they’re seeing that there they did away with the endometrium and he did away with where they saw a rise of progesterone now again why would i suggest that you do a progesterone level not before but if you’re using a medicated cycle without down-regulation remember there’s a cancellation rate and a cancellation rate goes up to almost ten percent
Now in those cases what do you want you want to know whether there has been some amount of a variant activity going on and what whatever activity will be detriment to changing the implantation window the implantation window has changed if there’s a rise of progesterone which means that if your intervention that progesterone is preceded by the ovarian intervention
Of progesterone you lose that valuable 120 r plus minus 3 hours of implantation windom and that’s something to be understood now look at the four groups group one again this is a communist group less than 21 days or equal to two weeks group two 22 to 28 days for weeks group three 29 to 35 days five weeks and group 4 36 to 48 days equal to or more than six weeks
And this is interesting let’s have a look at the pregnancy rates i’ve looked at the libor rate medical pregnancy rates and the early pregnancy loss your best results came when the duration of estudian treatment was about between three less than three or four weeks your highest live birth rate came in less than 21 days but statistically 22 to 28 days did not go
Completely off the mark so less than four weeks you had a live birth rate between twenty eighty seven point eight percent to twenty seven point seven percent and clinical pregnancy rate which is very much similar and an early pregnancy loss which was twenty eight point five percent for less than 21 days and thirty one percent in twenty to twenty eight days now as
The duration of extrusion gets longer then it was a live birth rate dropped down to twenty one point eight percent and the early pregnancy lost climbed up to thirty four point three percent but as the pregnancy student therapy prolonged for much longer duration and became between almost of six weeks the live birth rate took a drastic drop at 17.2% and the early
Pregnancy loss took a rise at forty eight point six percent now what does this paper tell you for it to be published in human reproductive production it needs to have a certain amount of weight age plus it should answer some questions which clinically are important to us so if we have a look at this and say well if your bridge is student treatment goes longer and
Longer what are you trying to do you’re trying to build the endometrium which is failing to build even after three weeks and then if you have a look at it closely you will see that there is a drop to the endometrium that means it’s rise is very small its vascularity changes and there is in some women a beautiful down-regulation that starts that in fact that’s
Hampering or rather changes the intervention and probably that may be one of the causes why your implantation tends to get worse in my practice i have a very simple policy if my surgeon treatment goes beyond three weeks i’d normally tend to stop it i generally believe that if you’re extrusion climbs up at a certain dose depending on what those you start you can
Start with two milligram that is a smaller dose i will gradual rise of estrogen milling a natural cycle and probably closer to a physiological rise of estrogen draw back the pituitary does not sense that rise of extortion and starts slowly allowing the follicle to grow and that’s one of the problems was starting in the lower dose another mohammed and sophie would
Have come for the course which i do and they i’ll show you those techniques in which which patients used to decide to give a small low dose proceeded and slowly increase it all move to transdermal patches and in those cases what you want there you’re pitiful to interfere less you start with the higher dose i do not believe that going beyond ten milligram of robyn
Aurora still valid does not seem to help really and that’s something which i hope is a take-home message on a short enough but here i think we can learn something from this paper the longer your estrogen your pregnancy rates tend to not going down i hope you enjoyed this talk again a short talk which answers some questions do share these videos because it allows
Knowledge to spread i do them in my spare time i put in a lot of effort to get these videos ready and i’ll be extremely grateful if they are shared across so they help you improve clinical care across in all departments thank you very much you
Transcribed from video
Estrogen treatment for Frozen Embryo treatment : How long ? By Fertility Courses