Browsing by Author "Demir, Berfu"

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Citation - WoS: 4
Citation - Scopus: 4
Individualized Luteal Phase Support in Frozen-Thawed Embryo Transfer After Intramuscular Progesterone Administration Might Rectify Live Birth Rate
(Frontiers Media Sa, 2024) Boynukalin, Fazilet Kubra; Tohma, Yusuf Aytac; Yarkiner, Zalihe; Gultomruk, Meral; Bozdag, Gurkan; Ozkavukcu, Sinan; Demir, Berfu; 01. Atılım University
Background: The serum P concentrations are suggested to have an impact on pregnancy outcome. However there is no consensus about the optimal progesterone cut-off during the luteal phase. Few studies evaluated the effectiveness of a "rescue protocol" for low serum P concentrations and most of these studies used vaginal progesterone administration. There is paucity of data on the effectiveness of rescue protocol using intramuscular progesterone (IM-P) in frozen-thawed embryo transfer (FET). Methods: This study is a retrospective cohort study included 637 single or double blastocyst FETs with artificially prepared endometrium receiving 100 mg IM progesterone (P) after incremental estrogen treatment. Serum P concentrations were evaluated using blood samples obtained 117-119 hours after the first IM-P administration and 21 +/- 2 hours after the last IM-P administration. Patients with serum P concentrations <20.6 ng/ml on the ET day were administrated 400 mg vaginal progesterone for rescue. Results: Demographic and cycle characteristics were similar between patients receiving rescue vaginal P (embryo transfer (ET)-day P concentration < 20.6 ng/ml) and patients who did not need rescue vaginal P (ET-day P concentration >= 20.6 ng/ml). Clinical pregnancy, miscarriage, and live birth rates were similar between two groups: 52.9%(45/85) vs 59.6%(326/552), p=0.287; 11.1%(5/45) vs 14.1%(46/326), p=0.583; and 47.1%(40/85) vs 50.7%(280/552), p=0.526, respectively. Logistic regression analysis revealed that the female age (p = 0.008, OR=0.942, 95% CI = 0.902-0.984) and embryo quality (ref: good quality for moderate: p=0.02, OR=0.469, 95% CI =0.269-0.760; for poor: p=0.013, OR= 0.269, 95% CI = 0.092-0.757) were independent variables for live birth. Following rescue protocol implementation, ET-day P concentration was not a significant predictor of live birth. Conclusions: Rescue vaginal P administration for low ET day serum P concentrations following IM-P yields comparable live birth rates.
Serum Progesterone Variability on Embryo Transfer Day in Hormone Replacement Therapy Cycles Using Intramuscular Injections During Frozen Embryo Transfers
(Springer/plenum Publishers, 2025) Boynukalin, Fazilet Kubra; Tohma, Yusuf Aytac; Demir, Berfu; Gultomruk, Meral; Polyzos, Nikolaos P.; Bahceci, Mustafa; Bozda, Gurkan; 01. Atılım University
Purpose To assess the intra-individual variability of serum progesterone (P) levels on embryo transfer (ET) day, when the same dose of intramuscular progesterone (IM-P) was used in two consecutive hormone replacement therapy (HRT) frozen embryo transfer (FET) cycles. Methods A total of 75 patients undergoing two consecutive HRT-FET cycles in one year performed at Bahceci Ankara IVF Center between November 2019 and February 2022 were retrospectively analyzed. Serum P levels were measured at the 117th-119th hours of support by a single laboratory. The two measurements of P levels performed on the day of the first and the second FET were compared to evaluate the intra-individual variability of serum P levels. Results Comparisons between the 1st and 2nd FET cycles revealed statistically significant intra-individual variation, with an average difference of -2.47 ng/mL (95% CI: -4.65 to -0.29, p = 0.027) between the two consecutive measurements. To assess their consistency, the limit of agreement was also tested with the Bland-Altman method, in which the mean difference (+ 1.96 x SD and -1.96 x SD) was -2.47 (16.1 and -21.1). Based on a previous study, the frequency of low P levels, as expressed by being > 20.6 ng/mL on ET day, was similar between the 1st and 2nd FET cycles (14.7% vs. 9.3%, p = 0.31). Notably, most patients had improved P levels in the second cycle if initially low, while decreases were rare among those with initially higher levels. Conclusion Serum P levels may vary within the same individual across FET cycles despite the use of the same dosage of IM-P. Increasing maternal age, high body mass index, and fluctuating estradiol levels on the day of ET were identified as risk factors contributing to this variability.
Citation - Scopus: 2
Yapay Dondurulmuş-Çözdürülmüş Blastokist Transferi Yapılan Hastalarda Embriyo Transferi Günündeki Yüksek Serum Progesteron Düzeyleri: Tavan Etkisi Var Mı
(Turkish Society of Obstetrics and Gynecology, 2024) Findikli, Necati; Demir, Berfu; Tohma, Yusuf Aytaç; Bozdag, Gurkan; Bahcecı, Mustafa; Dündar, Betül; Boynukalin, Fazilet Kubra; 01. Atılım University
Amaç: Yapay dondurulmuş-çözünmüş blastosist transferi (FET) siklusu uygulanan hastalarda embriyo transfer gününde yüksek serum progesteron düzeylerinin gebelik sonuçları üzerindeki tavan etkisi olup olmadığını değerlendirmeyi amaçladık. Gereç ve Yöntemler: Bu çalışma yapay FET döngüsü uygulanan 595 hastayı içeren retrospektif bir kohort çalışmasıydı. Progesteron düzeylerine göre yüzdelik dilimleri değerlendirdiğimizde 40,6 ng/mL 90. yüzdeliğe, 23,9 ng/mL ise 50. yüzdeliğe karşılık geliyordu. Bu bulguya dayanarak progesteron düzeyi kesme noktasını <20 ng/mL, n=220 (%37,0); 20-40 ng/mL, n=312 (%52,4) ve ≥40 ng/mL, n=63 (%10,6) olarak belirledik. Birincil sonuç ölçüsü, klinik gebelik (CPR) ve canlı doğum oranı (LBR) olarak belirlendi. Bulgular: Blastokist morfolojisi olarak genişleme derecesi, trofoektoderm ve iç hücre kitle derecesi klinik gebelik ile istatistiksel olarak anlamlı düzeyde ilişkili olduğunu bulduk (hepsi için p<0,001) ve 20-40 ng/mL arasındaki progesteron düzeyinin ise daha yüksek CPR ile ilişkili olduğunu bulduk (p=0,043). Çok değişkenli analizde; CPR ile ilişkili faktörler yalnızca blastosist genişlemesi ve iç hücre kütle derecesi bağımsız ve anlamlı faktörlerdi [p=0,011, (odds oranı) OO=1,6, güven aralığı (GA) 95%=1,13-2,39 ve p=0,007, OO=1,65, GA 95%=1,14-2,39, sırasıyla]. Progesteron düzeyi ve trofoektoderm derecesi istatistiksel olarak anlamlı bulunmadı. Faktörler ile LBR arasındaki ilişkinin değerlendirilmesinde sadece blastokist genişleme derecesi 4’e eşit veya üzerinde ve trofektoderm derecesi A veya B istatistiksel olarak anlamlı LBR ile ilişkiliydi. Sonuç: Bu verilere göre yapay FET siklusu yapılan hastalarda embriyo transferi gününde serum P4 düzeyi 40 ng/mL’nin üzerinde ise kullanılan progesteron dozunun azaltılmasına gerek olmadığını düşündük.