Subcutaneous progesterone administration provides a similar ongoing pregnancy rate compared with intramuscular progesterone administration in hormone replacement therapy frozen embryo transfer cycles

Boynukalin F. K., Abali R., Gultomruk M., Demir B., Yarkiner Z., Karlikaya G., ...More

F and S Reports, vol.4, no.2, pp.165-172, 2023 (Scopus) identifier

  • Publication Type: Article / Article
  • Volume: 4 Issue: 2
  • Publication Date: 2023
  • Doi Number: 10.1016/j.xfre.2022.11.002
  • Journal Name: F and S Reports
  • Journal Indexes: Scopus
  • Page Numbers: pp.165-172
  • Keywords: frozen embryo transfer, intramuscular progesterone, luteal support, subcutaneous progesterone
  • Istanbul University Affiliated: No


Objective: To compare the ongoing pregnancy rates (OPRs) for subcutaneous progesterone (SC-P) to intramuscular progesterone (IM-P) in hormone replacement therapy used in frozen embryo transfer (FET) cycles. Design: Prospective nonrandomized cohort study. Setting: Private fertility clinic. Patient(s): The study enrolled 224 patients scheduled for hormone replacement therapy (HRT)-FET cycles with SC-P (n = 133) or IM-P (n = 91). The route of P administration was decided according to the patient's preference and accessibility to the hospital. In the first FET cycle of a freeze-all cycle using single blastocyst transfers, a woman aged ≤35 was included. Main Outcome(s): Ongoing pregnancy (OP). Result(s): The demographic, cycle, and embryologic characteristics were similar between groups. The clinical pregnancy rates (86/133[64.7%] vs. 57/91[62.6%]); miscarriage rates (21/86 [24.4%] vs. 10/57 [17.5%]), and OPR (65/133 [48.9%] vs. 47/91 [51.6%]) were comparable between the SC-P and IM-P groups. Binary logistic regression for OP as the dependent factor revealed that blastocyst morphology was found to be a significant independent prognosticator (for poor quality embryos adjusted odds ratio, 0.11; 95% confidence interval, 0.029-0.427) and progesterone route (SC-P vs. IM-P) was an insignificant prognosticator (adjusted odds ratio, 0.694; 95% confidence interval, 0.354–1.358). Conclusion(s): The OPR for SC-P administration was similar to that for IM-P in HRT-FET cycles. The effect of ET-day P levels may vary regarding the administration route. Randomized controlled trials comparing different P administration routes are needed, and large-scale prospective trials are warranted to evaluate the ET-day P levels on pregnancy outcome.