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The Role of Progesterone in Assisted and Unassisted Human Reproduction

Kate Devine, MD

Thursday, May 6
3:45 PM – 4:30 PM

 0.75 CME

Session Description:

The current trend in ART is increasingly towards transfer of vitrified warmed blastocysts, and in the era of PGT to select an optimal blastocyst for transfer, perfecting endometrial preparation for frozen embryo transfer is the final frontier. The optimal dose, timing, and route of progesterone replacement in programmed endometrial preparation cycles are not known, yet we must make decisions on behalf of our patients, as we strive to provide the highest live birth rates from frozen embryo transfer. In this session we will discuss primarily the optimal route of progesterone administration in light of our recent three armed large noninferiority study evaluating vaginal versus intramuscular progesterone. Secondary topics will include dose and timing of progesterone replacement in FET cycles as programmed versus natural cycle FET.

Session Objectives:

  1. Review RCT Data regarding optimal route of progesterone replacement for FET.
  2. Discuss why vaginal progesterone replacement only is associated with significantly lower implantation and higher miscarriage than regimens containing intramuscular data.
  3. Discuss the mechanism for sub-optimal outcomes using vaginal progesterone only.
  4. Review survey data on patient preferences regarding mode of progesterone replacement.
  5. Identify potential benefits of alternative endometrial preparations, including natural cycle FET and of supplemental diagnostic testing to optimize endometrial receptivity.

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