Patient experience in a randomized trial of a weekly progesterone vaginal ring versus a daily progesterone gel for luteal support after in vitro fertilization

Abstract

Objective: To assess patient experience and convenience of using progesterone vaginal ring (VR) versus vaginal gel for women requiring luteal phase support during in vitro fertilization (IVF). Design: Post hoc analysis of a prospective, randomized, single-blind, multicenter, phase 3 clinical trial. Setting: Twenty-two U.S. IVF centers. Patient(s): Women undergoing IVF (N ¼ 1,297). Intervention(s): Randomization to weekly VR or daily gel the day after egg retrieval for up to 10 weeks, with fresh embryo transfer IVF per site-specific procedures. Main Outcome Measure(s): Patient satisfaction questionnaire completed at final study visit. Result(s): In the women who were taking R1 dose of either VR (n ¼ 647) or gel (n ¼ 650), >97% reported that learning to use the formulation, remembering to take it at the correct time, and using it as prescribed was ''easy'' or ''somewhat easy.'' More VR than gel users reported noninterference with daily activity (93.3% vs. 74.7%, P< .001), sexual comfort (80.3% vs. 67.8%, P< .001), and sexual desire (73.8% vs. 61.8%, P< .001), as well as not being bothered during sexual intercourse (66.9% vs. 39.2%, P< .001). More gel than VR users reported no difficulty with application (97.4% vs. 80.9%, P< .001). Among women who had previously used progesterone during IVF, more VR users than gel users preferred their currently assigned treatment to their previous treatment (91.4% vs. 83.0%, P¼ .03). Conclusion(s): Weekly progesterone VR and daily progesterone gel were easy to use, with limited impact on quality of life. Overall, the VR appeared to interfere less with daily life, social activities, and sexual activity although the gel was less difficult or stressful to apply.

Dydrogesterone as an oral alternative to vaginal progesterone for IVF luteal phase support: A systematic review and individual participant data meta-analysis

“…Aside from the differences in efficacy between oral dydrogesterone and MVP identified in this study, the administration route of oral dydrogesterone may be advantageous as patients usually prefer to use oral preparations compared to vaginal ones [26,57,58]. This may be due to the overall inconvenience [59], administration-related side effects [14,15], and cultural barriers associated with using MVP [9]. Although MVP may be the most prescribed route of luteal phase support administration [7], it may not be the most preferred route of administration since women often find vaginal preparations less appealing than oral administration, particularly due to comfort issues [60].…”

Simplifying luteal phase support in stimulated assisted reproduction cycles

“…Even though the study by Ginsburg et al (5) was conducted in 2008-2009, the weekly vaginal ring used in this study is still not clinically available, nor is there any evidence online to indicate that the product ever will be available. The study by Ginsburg et al (5) has clearly demonstrated that the patients found using weekly vaginal rings was more convenient, interfering less with their daily, social, and sexual activities. If the vaginal ring were to become clinically available, the…”

Luteal-phase support in assisted reproductive technology: An ongoing challenge

“…However, a threefold higher rate of vaginal discharge was reported in the vaginal ring group (26). Ginsburg et al explained that women preferred weekly vaginal rings to vaginal gel because they were more convenient with no interference with daily and sexual activities, even though the gel was less difficult and stressful to apply (27). The most common complaints about vaginal progesterone are increased vaginal International Journal of Reproductive BioMedicine Dashti et al…”