Progesterone in frozen embryo transfer cycles: assays, circulating concentrations, metabolites, and molecular action - PubMed (original) (raw)

Progesterone in frozen embryo transfer cycles: assays, circulating concentrations, metabolites, and molecular action

Rachel Mandelbaum et al. F S Rep. 2024.

Abstract

Programmed or medicated frozen embryo transfer cycles rely on exogenous progesterone (P) administration to prepare the endometrium for implantation and maintain pregnancy. Presently, the optimal route and dose of P replacement for frozen embryo transfer are not known. In addition, there is a paucity of data and insufficient understanding regarding the metabolism and actions of P in implantation and pregnancy maintenance. In the present review, we discuss how different P assay methodologies affect the determination of P thresholds for implantation and pregnancy maintenance. In addition, we discuss the importance of free P and its regulation in the endometrium and show the complexity of molecular signaling that is required for P-dependent endometrial receptivity. We concluded that future studies should focus on defining accurate circulating and endometrial P concentrations, both for total and free P, and how these concentrations correlate with endometrial receptivity and clinical outcomes.

Keywords: Progesterone; assay methodology; assisted reproductive technology; frozen embryo transfer; metabolites.

© 2024 The Authors.

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Conflict of interest statement

R.M. has nothing to disclose. F.Z.S. has nothing to disclose.

Figures

Figure 1

Figure 1

Chemical structure of progesterone.

Figure 2

Figure 2

Molecular signaling for progesterone-dependent endometrial receptivity. Reused with permission (76). COUP-TFII = chicken ovalbumin upstream promoter transcription factor II; ERK = extracellular signal regulated kinase; ESR1 = estrogen receptor alpha 1; FGR = fibroblast growth factor; FGFR = fibroblast growth factor receptor; IHH = Indian hedgehog; MUC1 = mucin1; PGR = progesterone receptors; PTCH = patched-1; SMO/GLI = smoothened and glioma-associated oncogene homolog.

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