Browsing by Author "Gultomruk, Meral"

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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.