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Evaluation of progestogen supplementation for luteal phase support in fresh in vitro fertilization cycles

Mohammed, Amal; Woad, Kathryn J.; Mann, George E.; Craigon, Jim; Raine-Fenning, Nick; Robinson, Robert S.

Authors

Amal Mohammed

KATIE WOAD katie.woad@nottingham.ac.uk
Assistant Professor

George E. Mann

Jim Craigon

NICK RAINE-FENNING Nick.Raine-fenning@nottingham.ac.uk
Clinical Associate Professor &reader in Reproductive Medicineand Surgery



Abstract

© 2019 American Society for Reproductive Medicine Objective: To evaluate the effectiveness of progestogen supplementation in improving clinical pregnancy rates in women undergoing fresh IVF cycles and to compare different routes, start times, durations, and estrogen coadministration regimen. Design: Comprehensive systematic review and meta-analysis. Setting: University. Patient(s): Women undergoing fresh IVF cycles who did and did not receive progestogen supplementation. Intervention(s): Summary odds ratios (ORs) were calculated by binomial logistic regression. Main Outcome Measure(s): Clinical pregnancy rates. Result(s): Eighty-two articles (26,726 women) were included. Clinical pregnancy rates were increased by IM (OR = 4.57), vaginal (OR = 3.34), SC (OR = 3.36), or oral (OR = 2.57) progestogen supplementation versus no treatment. The greatest benefit was observed when progestogens were supplemented IM versus vaginally (OR = 1.37). The optimal time to commence administration was between oocyte retrieval and ET (OR = 1.31), with oocyte retrieval +1 day being most beneficial. Coadministration of estrogen had no benefit (OR = 1.33), whether progestogens were coadministered vaginally or IM. Clinical pregnancy rates were equivalent when progestogen supplementation was ceased after ≤3 weeks or continued for up to 12 weeks (OR = 1.06). Conclusion(s): This broad-ranging meta-analysis highlights the need to reevaluate current clinical practice. The use of progestogens in fresh IVF cycles is substantially beneficial to clinical pregnancy. Critically, the use of IM progestogens should not be dismissed, as it yielded the greatest clinical pregnancy rates. Pregnancy success was impacted by initiation of therapy, with 1 day after oocyte retrieval being optimal. There is little evidence to support coadministration of estrogen or prolonging progestogen treatment beyond 3 weeks.

Citation

Mohammed, A., Woad, K. J., Mann, G. E., Craigon, J., Raine-Fenning, N., & Robinson, R. S. (2019). Evaluation of progestogen supplementation for luteal phase support in fresh in vitro fertilization cycles. Fertility and Sterility, 112(3), 491-502.e3. https://doi.org/10.1016/j.fertnstert.2019.04.021

Journal Article Type Article
Acceptance Date Apr 11, 2019
Online Publication Date Jun 11, 2019
Publication Date 2019-09
Deposit Date Apr 12, 2019
Publicly Available Date Jun 12, 2020
Journal Fertility and Sterility
Print ISSN 0015-0282
Electronic ISSN 1556-5653
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 112
Issue 3
Pages 491-502.e3
DOI https://doi.org/10.1016/j.fertnstert.2019.04.021
Keywords Obstetrics and Gynaecology; Reproductive Medicine
Public URL https://nottingham-repository.worktribe.com/output/1786282
Publisher URL https://www.sciencedirect.com/science/article/pii/S0015028219303966?via%3Dihub

Files

2019 Fs 27600 Mohammed Et Al Accepted Publication (937 Kb)
PDF

Publisher Licence URL
http://creativecommons.org/licenses/by-nc-nd/4.0/





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