Introduction: Luteal phase deficiency following assisted reproductive technology (ART) programmes has led to progestogen supplementation. However, there is debate over which route of progestogen administration (intramuscular or vaginal) is most beneficial and whether additional treatment with oestrogen further improves pregnancy rates. Thus, a large-scale meta-analysis was performed to investigate the benefit of these luteal phase support treatments on pregnancy outcome in women undergoing ART.
Methods: Literature searches (Google Scholar, PubMed, Medline and Web of Science) from 1980 to 2015 identified 112 studies (n=18792 cycles) with progestogen supplementation via intramuscular or vaginal routes. These were sub-divided by time that supplementation started: at oocyte retrieval [OoR], between OoR and embryo transfer [OoR-ET] or at ET. For comparison of additional oestrogen treatment, 21 studies (n=1702 cycles) were identified, which were sub-divided based on start time [at OoR or OoR-ET] and route (intramuscular or vaginal) of progestogen supplementation. The effect of the different treatments on the odds ratio (OR) of a clinical pregnancy was determined by logistic regression analysis.
Results and discussion: Overall, pregnancy rates were greater when progestogen was supplemented via intramuscular (P<0.01) versus vaginal routes. Clinical pregnancy rates were greater in the intramuscular progestogen supplementation group at OoR (OR=1.50, P<0.001) and OoR-ET (OR=1.30, P<0.001) but lower at ET, (OR=0.75, P<0.05) compared with vaginal route. Oestrogen treatment increased pregnancy rates when progestogen was supplemented by intramuscular (OR=1.48, P<0.001) and vaginal (OR=1.33, P<0.001) routes. Oestrogen treatment greatly increased pregnancy rates when progestogen supplementation was started at OoR-ET (OR=1.95, P<0.001) but was only marginal at OoR (OR=1.15, P<0.05). Pregnancy rates were greatest when progestogen was administered intramuscularly but only when progestogen supplementation was started at the optimum time. Additional oestrogen treatment further increased pregnancy rates when progestogen was administered intramuscularly or vaginally.
11 Jul 2016 - 11 Jul 2016