Progesterone luteal support after ovulation induction and intrauterine insemination: an updated systematic review and meta-analysis

Green, Katherine A.; Zolton, Jessica R.; Schermerhorn, Sophia M; Lewis, Terrence D.; Healy, M.W.; Terry, Nancy; DeCherney, Alan H.; Hill, Micah J.

doi:10.1016/j.fertnstert.2017.01.011

Cited by 57 publications

(36 citation statements)

References 39 publications

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“…In a review and meta-analysis including the above mentioned studies, Miralpeix et al concluded that the supplementation of luteal phase with vaginal progesterone significantly increases live birth among women undergoing IUI when receiving gonadotropins for ovulation induction, and women receiving CC to induce ovulation do not seem to benefit from this treatment [ 19 ]. These findings were consistent with two other systematic review and meta-analysis conducted by Green et al and Hill et al [ 20 , 21 ].…”

Section: Discussionsupporting

confidence: 93%

Does Luteal Phase Support Effect Pregnancy Rates in Intrauterine Insemination Cycles? A Prospective Randomised Controlled Study in a Tertiary Center

Keskin

Aytaç

2020

Obstetrics and Gynecology International

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Intrauterine insemination (IUI) is a common treatment for couples with subfertility. Clomiphene citrate, gonadotropins, and letrozole are used for ovulation induction in IUI cycles. It has been well documented that luteal support with exogenous progesterone after in vitro fertilization is associated with higher pregnancy and live birth rates. Yet, luteal phase support in IUI cycles has become a debatable issue. The aim of this prospective controlled study was to assess the effect of luteal phase vaginal progesterone supplementation on β-hCG positivity and clinical pregnancy rates in women undergoing IUI. This prospective controlled randomised study was conducted at a tertiary infertility center. 87 patients with unexplained infertility or male subfertility who were treated with IUI using gonadotropins were enrolled. Patients in the study group (n = 44) received luteal phase vaginal progesterone supplementation. Patients in the control group (n = 43) did not receive any luteal phase support. There was no statistical difference between two groups in terms of β-hCG positivity and clinical pregnancy rates. Our findings do not show any beneficial effect of luteal phase support in IUI cycles stimulated with gonadotropins. Although luteal phase support in IUI cycles stimulated with gonadotropins is widely adopted, there is a lack of robust evidence.

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Section: Discussionsupporting

confidence: 93%

Does Luteal Phase Support Effect Pregnancy Rates in Intrauterine Insemination Cycles? A Prospective Randomised Controlled Study in a Tertiary Center

Keskin

Aytaç

2020

Obstetrics and Gynecology International

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“…A meta-analysis, which found progesterone luteal support to be beneficial in patients undergoing ovulation induction with gonadotropins in IUI cycles, did recommend vaginal progesterone due to low cost and side effect profile. However, all included studies were triggered with hCG [28]. As progesterone is secreted in a pulsatile manner, there is no standard to define what value of progesterone results in luteal phase deficiency [29].…”

Section: Discussionmentioning

confidence: 99%

GnRH Agonist versus hCG Trigger in Ovulation Induction with Intrauterine Insemination: A Randomized Controlled Trial

Lê

Nguyen

Zolton

et al. 2019

International Journal of Endocrinology

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This study is aimed at comparing clinical pregnancy rates (CPRs) in patients who are administered either gonadotropin-releasing hormone agonist (GnRHa) or human chorionic gonadotropin (hCG) for ovulation trigger in intrauterine insemination (IUI) cycles. A prospective randomized comparative study was conducted at Hue University Hospital in Vietnam. A total of 197 infertile women were randomly assigned to receive either GnRHa trigger (n=98 cycles) or hCG trigger (n=99 cycles) for ovulation trigger. Patients returned for ultrasound monitoring 24 hours after IUI to confirm ovulation. A clinical pregnancy was defined as the presence of gestational sac with fetal cardiac activity. There was no difference in ovulation rates in either group receiving GnRHa or hCG trigger for ovulation. Biochemical and CPR were higher in patients who received hCG (28.3% and 23.2%) versus GnRHa (14.3% and 13.3%) (p=0.023, OR 0.42, 95%CI=0.21−0.86 and p=0.096, OR 0.51, 95%CI=0.24−1.07, respectively). After adjusting for body mass index (BMI) and infertility duration, there was no difference in CPR between the two groups (OR 0.58, 95% CI 0.27-1.25, p=0.163). In conclusion, the use of the GnRHa to trigger ovulation in patients undergoing ovulation induction may be considered in patients treated with IUI.

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“…While previous quantitative analyses of interventions for LPS have investigated a broad scope encompassing intramuscular, oral, rectal and vaginal routes of progesterone for LPS (Green et al, 2017;van der Linden et al, 2015) just one previous analysis based on a literature review conducted in 2009 had investigated vaginal progesterone preparations for LPS in IVF/ICSI cycles specifically, comparing Crinone with Utrogestan Vaginal, Cyclogest or Endometrin (Polyzos et al, 2010). The current review compared any vaginal progesterone formulation with any other, including studies that investigated dosage and timing of administration of LPS, for any type of assisted reproductive technology cycle including IVF and ICSI, as well as IUI, thus providing a broader picture of the role that vaginal progesterone plays as LPS in assisted reproductive technology cycles.…”

Section: Discussionmentioning

confidence: 99%

Systematic review of the clinical efficacy of vaginal progesterone for luteal phase support in assisted reproductive technology cycles

Child

Leonard

Evans

et al. 2018

Reproductive BioMedicine Online

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Vaginal progesterone via capsule, gel or tablet is the most common route for luteal phase support (LPS) in Europe. Although there is a wealth of data comparing products used at other stages of assisted reproductive technology cycles, there is a lack of systematically identified evidence comparing the wide range of vaginal progesterone products. This systematic review queried the MEDLINE, Embase and Cochrane Library databases on 30 June 2016 to identify head-to-head randomized controlled trials (RCTs) comparing the efficacy or safety of vaginal progesterone preparations (Crinone, Cyclogest, Lutigest or Utrogestan Vaginal) for LPS in assisted reproductive technology cycles. Of 1914 results, 18 RCTs were included. No significant difference in clinical pregnancy rate was identified in comparisons of Utrogestan Vaginal with Crinone. Utrogestan Vaginal and Lutigest were non-inferior to Crinone in ongoing pregnancy rate comparisons. Differences in patient-reported perineal irritation with Crinone and Lutigest were not significantly different to Cyclogest. In studies comparing varying timing or dosage of Utrogestan Vaginal or Crinone, no significant differences were observed. These results suggest Crinone, Cyclogest, Lutigest and Utrogestan Vaginal represent equally safe and effective choices of vaginal progesterone for LPS in assisted reproductive technology cycles. Future quantitative analyses could provide further support for these findings.

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Progesterone luteal support after ovulation induction and intrauterine insemination: an updated systematic review and meta-analysis

Cited by 57 publications

References 39 publications

Does Luteal Phase Support Effect Pregnancy Rates in Intrauterine Insemination Cycles? A Prospective Randomised Controlled Study in a Tertiary Center

Does Luteal Phase Support Effect Pregnancy Rates in Intrauterine Insemination Cycles? A Prospective Randomised Controlled Study in a Tertiary Center

GnRH Agonist versus hCG Trigger in Ovulation Induction with Intrauterine Insemination: A Randomized Controlled Trial

Systematic review of the clinical efficacy of vaginal progesterone for luteal phase support in assisted reproductive technology cycles

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