Oral micronized progesterone combined with vaginal progesterone gel for luteal support

Abstract

The aim of the present study was to compare the efficacy and satisfaction rate of combined therapy of oral micronized progesterone capsules and vaginal progesterone gel versus monotherapy with vaginal progesterone gel in luteal support. A case-control study was performed on a total number of 370 women aged <45 years undergoing IVF-ET treatment. The patients received either combination of Crinone 8% vaginal gel, 90 mg daily dose and Utrogestan oral capsules 3 x 100 mg, or Crinone 8% vaginal gel, 90 mg daily. Progesterone supplementation begun on the day of oocyte retrieval and continued until pregnancy was tested and in the case of pregnancy until week 8. The comparable rates of ongoing pregnancies were noted with use of combined-progesterone therapy (39.5%) and progesterone-monotherapy (33.5%). Abortion rate (6.4% vs. 15.6%) was significantly lower with the use of combined therapy. Tolerability and satisfaction of both supplements was almost equal but bleeding occurred more frequently in the progesterone-monotherapy group. In conclusion, the efficacy, satisfaction and tolerability of combined and vaginal progesterone supplements were comparable, but bleeding in early pregnancy and abortion rate presented more frequently with the use of vaginal progesterone.

Hormonal medication in medically assisted reproduction: a systematic review of assessments from patients

“…After screening the full texts, a total of 318 papers were excluded as they did not meet the eligibility criteria. Finally, 34 papers were included in this systematic review (Aghssa et al, 2008(Aghssa et al, , 2012Alviggi et al, 2007;Bergh et al, 2012;Dickey et al, 2002Dickey et al, , 2003European and Israeli Study Group on Highly Purified Menotropin versus Recombinant Follicle-Stimulating Hormone, 2002;European and Middle East Orgalutran Study Group, 2001;Germond et al, 2002;Gocial et al, 2000;Greco et al, 2005;Hovatta et al, 2009;Kang et al, 2011;Kettel et al, 2004;Keye et al, 2005;Lan et al, 2008;Lavery et al, 2008;Lockwood et al, 2014;Ng et al, 2003Ng et al, , 2007Nichols et al, 2001;Out et al, 1997;Pang et al, 2003;Porter et al, 2008;Pouly et al, 1996;Schoolcraft et al, 2000;Simunic et al, 2007;Somkuti et al, 2006;Tomic et al, 2011Tomic et al, , 2015Utsunomiya et al, 2012;Verhoeff et al, 1997;Welcker et al, 2010;Zorn et al, 2001). One paper actually reported on two separate studies (Porter et al, 2008).…”

“…With respect to the studied populations (including a total of 14,870 patients), the median sample size per study was 147 female fertility patients and the most common treatment type was ART (n = 32/35; Aghssa et al, 2008Aghssa et al, , 2012Alviggi et al, 2007;Bergh et al, 2012;Dickey et al, 2002Dickey et al, , 2003European and Israeli Study Group on Highly Purified Menotropin versus Recombinant Follicle-Stimulating Hormone, 2002;European and Middle East Orgalutran Study Group, 2001;Germond et al, 2002;Gocial et al, 2000;Greco et al, 2005;Hovatta et al, 2009;Kang et al, 2011;Keye et al, 2005;Lan et al, 2008;Lavery et al, 2008;Lockwood et al, 2014;Ng et al, 2003Ng et al, , 2007Out et al, 1997;Pang et al, 2003;Porter et al, 2008 [German pilot study]; Porter et al, 2008 [Australian study];Pouly et al, 1996;Schoolcraft et al, 2000;Simunic et al, 2007;Tomic et al, 2011Tomic et al, , 2015Utsunomiya et al, 2012;Verhoeff et al, 1997;Welcker et al, 2010;Zorn et al, 2001). Recruitment took place in various regions around the world (mostly Europe; n = 18/35; Alviggi et al, 2007;Bergh et al, 2012;European and Israeli Study Group on Highly Purified Menotropin versus Recombinant Follicle-Stimulating Hormone, 200...…”

“…1 presents the risk of bias within each study. This review included studies with different designs, including RCT (n = 24; Aghssa et al, 2008Aghssa et al, , 2012Alviggi et al, 2007;Bergh et al, 2012;Dickey et al, 2002Dickey et al, , 2003 Group, 2001;Germond et al, 2002;Gocial et al, 2000;Greco et al, 2005;Kang et al, 2011;Keye et al, 2005;Lan et al, 2008;Lockwood et al, 2014;Ng et al, 2003Ng et al, , 2007Nichols et al, 2001;Out et al, 1997;Porter et al, 2008 [German pilot study]; Pouly et al, 1996;Simunic et al, 2007;Tomic et al, 2015;Verhoeff et al, 1997), prospective cohort studies (n = 10;Hovatta et al, 2009;Kettel et al, 2004;Lavery et al, 2008;Pang et al, 2003;Porter et al, 2008 [Australian study];Schoolcraft et al, 2000;Somkuti et al, 2006;Utsunomiya et al, 2012;Welcker et al, 2010;Zorn et al, 2001) and a prospective casecontrol study (n = 1; Tomic et al, 2011).…”

“…The included studies proved that more than half of the tools (n = 17/33 tools used by n = 18/35 studies) could identify significant differences (i.e. discriminate) between medications (Aghssa et al, 2008(Aghssa et al, , 2012Bergh et al, 2012;Dickey et al, 2002Dickey et al, , 2003Gocial et al, 2000;Greco et al, 2005;Kang et al, 2011;Keye et al, 2005;Lavery et al, 2008;Lockwood et al, 2014;Ng et al, 2003Ng et al, , 2007Out et al, 1997;Pouly et al, 1996;Simunic et al, 2007;Tomic et al, 2011Tomic et al, , 2015. None of the tools assessed all seven medication characteristics, but only assessed one (n = 16/33 tools used by 16/35 references; Aghssa et al, 2008;Alviggi et al, 2007;Dickey et al, 2002;Dickey et al, 2003 Study Group, 2001;Germond et al, 2002;Gocial et al, 2000;Keye et al, 2005;Lan et al, 2008;Lavery et al, 2008;Lockwood et al, 2014;Nichols et al, 2001;Out et al, 1997;Tomic et al, 2011;Verhoeff et al, 1997), two (n = 10/33 tools used by n = 11/35 studies; Aghssa et al, 2012;Bergh et al, 2012;Greco et al, 2005;Hovatta et al, 2009;Kang et al, 2011;Kettel et al, 2004;…”

“…None of the tools assessed all seven medication characteristics, but only assessed one (n = 16/33 tools used by 16/35 references; Aghssa et al, 2008;Alviggi et al, 2007;Dickey et al, 2002;Dickey et al, 2003 Study Group, 2001;Germond et al, 2002;Gocial et al, 2000;Keye et al, 2005;Lan et al, 2008;Lavery et al, 2008;Lockwood et al, 2014;Nichols et al, 2001;Out et al, 1997;Tomic et al, 2011;Verhoeff et al, 1997), two (n = 10/33 tools used by n = 11/35 studies; Aghssa et al, 2012;Bergh et al, 2012;Greco et al, 2005;Hovatta et al, 2009;Kang et al, 2011;Kettel et al, 2004;Pang et al, 2003;Porter et al, 2008 [German pilot study]; Simunic et al, 2007;Tomic et al, 2015;Welcker et al, 2010), three (n = 5/33 tools used by 6/35 studies; Ng et al, 2003Ng et al, , 2007Porter et al, 2008 [Australian study];Pouly et al, 1996;Schoolcraft et al, 2000;Zorn et al, 2001) or four (n = 2/33 tools used by n = 2 studies; Somkuti et al, 2006;Utsunomiya et al, 2012) medication characteristics. All but four tools addressed 'side effects' (n = 30/33 tools used by n = 32/35 studies; Aghssa et al, 2008Aghssa et al, , 2012Alviggi et al, 2007;…”