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Zhao J, Hao J, Li Y. Individualized luteal phase support after fresh embryo transfer: unanswered questions, a review. Reprod Health 2022; 19:19. [PMID: 35065655 PMCID: PMC8783459 DOI: 10.1186/s12978-021-01320-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 12/23/2021] [Indexed: 12/20/2022] Open
Abstract
Background Luteal phase support (LPS) is an important part of assisted reproductive technology (ART), and adequate LPS is crucial for embryo implantation. At present, a great number of studies have put emphasis on an individualized approach to controlled ovarian stimulation (COS) and endometrium preparation of frozen- thawed embryo transfer (FET); However, not much attention has been devoted to the luteal phase and almost all ART cycles used similar LPS protocol bases on experience. Main body This review aims to concisely summarize individualized LPS protocols in fresh embryo transfer cycles with hCG trigger or GnRH-a trigger. The PubMed and Google Scholar databases were searched using the keywords: (luteal phase support or LPS) AND (assisted reproductive technology or ART or in vitro fertilization or IVF). We performed comprehensive literature searches in the English language describing the luteal phase support after ART, since 1978 and ending in May 2019. Recent studies have shown that many modified LPS programs were used in ART cycle. In the cycle using hCG for final oocyte maturation, the progesterone with or without low dose of hCG may be adequate to maintain pregnancy. In the cycle using GnRH-a for trigger, individualized low dose of hCG administration with or without progesterone was suggested. The optimal timing to start the LPS would be between 24 and 72 h after oocyte retrieval and should last at least until the pregnancy test is positive. Addition of E2 and the routes of progesterone administration bring no beneficial effect on the outcomes after ART. Conclusions Individualized LPS should be applied, according to the treatment protocol, the patients’ specific characteristics, and desires. Luteal phase support (LPS) is an important part of assisted reproductive technology (ART). In the cycle using hCG for final oocyte maturation, the progesterone with or without low dose of hCG may be adequate to maintain pregnancy. In the cycle using GnRH-a for trigger, individualized low dose of hCG administration with or without progesterone was suggested. The optimal timing to start the LPS would be between 24 and 72 h after oocyte retrieval and should last at least until the pregnancy test is positive. Addition of E2 and the routes of progesterone administration bring no beneficial effect on the outcomes after ART. Individualized LPS should be applied, according to the treatment protocol, the patients’ specific characteristics, and desires.
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Affiliation(s)
- Jing Zhao
- Reproductive Medicine Center, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha City, Hunan Province, People's Republic of China.,Clinical Research Center For Women's Reproductive Health In Hunan Province, Hunan, People's Republic of China
| | - Jie Hao
- Reproductive Medicine Center, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha City, Hunan Province, People's Republic of China.,Clinical Research Center For Women's Reproductive Health In Hunan Province, Hunan, People's Republic of China
| | - Yanping Li
- Reproductive Medicine Center, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha City, Hunan Province, People's Republic of China. .,Clinical Research Center For Women's Reproductive Health In Hunan Province, Hunan, People's Republic of China.
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Evaluation of fertilization, usable blastocyst development and sustained implantation rates according to intracytoplasmic sperm injection operator experience. Reprod Biomed Online 2020; 41:19-27. [PMID: 32466993 DOI: 10.1016/j.rbmo.2020.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 02/07/2020] [Accepted: 03/11/2020] [Indexed: 11/21/2022]
Abstract
RESEARCH QUESTION Is intracytoplasmic sperm injection (ICSI) operator experience associated with fertilization, usable blastocyst development and sustained implantation rates (SIR) when at least two embryologists carry out ICSI for a single cohort of oocytes? DESIGN A retrospective cohort study of all IVF/ICSI cycles at a single large infertility centre between 2008 and 2018. Cycles were included if a cohort of oocytes was split between two embryologists for ICSI. The embryologist's experience of ICSI was used to evaluate laboratory and clinical outcomes overall and by pairs of inseminating embryologists. Logistic regression, analysis of variance and Kruskal-Wallis testing were used where appropriate. RESULTS Analysis of 14,362 ICSI procedures showed an association between least ICSI experience and lower mean fertilization rates (P < 0.0001), higher odds of failed fertilization (adjusted OR 4.3; P < 0.0001) and lower number of fertilization 'wins' per cohort (P < 0.0001). Usable blastocyst development rates (number of usable blastocysts/number of two pronuclear zygotes) were not associated with ICSI embryologist experience (P = 0.44), but the odds of obtaining no usable blastocysts were higher (adjusted OR 1.4; P < 0.0001) and the proportion of usable blastocyst 'wins' was lower (P = 0.0001) when embryologists with the least experience carried out ICSI. Increased ICSI experience was associated with higher mean SIR (P < 0.0001). Laboratory and clinical outcomes were similar among embryologists once 1000 ICSI cycles and above were carried out. CONCLUSIONS Increased ICSI operator experience is associated with higher fertilization rates, SIR and a lower likelihood of failed fertilization and usable blastocyst development. Splitting a single oocyte cohort between more than one embryologist for ICSI is a quality-control measure that can be implemented.
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Scheffer JB, Scheffer BB, Carvalho RFD, Aguiar AP, Lozano DHM, Labrosse J, Grynberg M. A comparison of the effects of three luteal phase support protocols with estrogen on in vitro fertilization-embryo transfer outcomes in patients on a GnRH antagonist protocol. JBRA Assist Reprod 2019; 23:239-245. [PMID: 30875186 PMCID: PMC6724398 DOI: 10.5935/1518-0557.20190012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objective: This study aimed to evaluate the effects of three different luteal phase
support protocols with estrogen on the pregnancy rates and luteal phase
hormone profiles of patients undergoing in vitro
fertilization-embryo transfer (IVF-ET) cycles. A secondary objective was to
evaluate which ovarian reserve markers correlated with pregnancy rates. Methods: This retrospective observational study was carried out at a private tertiary
reproductive medicine teaching and research center. The study enrolled 104
patients undergoing intracytoplasmic sperm injection (ICSI) on an antagonist
protocol for controlled ovarian hyperstimulation (COH). The women were
divided into three groups based on the route of administration of estrogen
(E2) for luteal phase support: oral (Primogyna); transdermal patches
(Estradott); or transdermal gel (Oestrogel Pump). The administration of
estrogen provided the equivalent to 4 mg of estradiol daily. All women
received 600mg of vaginal progesterone (P) per day (Utrogestan) for luteal
phase support. Blood samples were drawn on the day of hCG administration and
on the day of beta hCG testing to measure E2 and P levels. Clinical
pregnancy rate (PR) was the main endpoint. Results: The patients included in the three groups were comparable. No significant
differences were found in implantation rates, clinical PR, miscarriage
rates, multiple-pregnancy rates, E2 or P levels on the day of beta hCG
measurement. Concerning ovarian reserve markers, significant correlations
between testing positive for clinical pregnancy and AMH (r = 0.66,
p<0.0001) and E2 levels on beta hCG measurement day (r =
0.77; p<.0001) were observed. Conclusions: No significant differences were seen in the pregnancy rates of patients
submitted to IVF-ET cycles with GnRH antagonists given oral, transdermal
patches, or transdermal gel E2 during the luteal phase. A correlation was
found between clinical pregnancy rate and AMH and E2 levels on beta hCG
testing day.
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Affiliation(s)
| | - Bruno Brum Scheffer
- IBRRA - Brazilian Institute of Assisted Reproduction, Belo Horizonte, MG, Brazil
| | | | - Ana Paula Aguiar
- IBRRA - Brazilian Institute of Assisted Reproduction, Belo Horizonte, MG, Brazil
| | - Daniel H Mendez Lozano
- School of Medicine, Tecnológico de Monterrey and Center for Reproductive Medicine CREASIS San Pedro Monterrey, México
| | - Julie Labrosse
- Department of Reproductive Medicine, Hôpital Jean Verdier (AP-HP), University Paris XIII
| | - Michael Grynberg
- Department of Reproductive Medicine, Hôpital Jean Verdier (AP-HP), University Paris XIII.,INSERM, U782, Clamart - France
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Asada Y, Hashiba Y, Hattori Y, Inoue D, Ito R, Fukunaga N, Sonohara M. Clinical utility of chlormadinone acetate (Lutoral™) in frozen-thawed embryo transfer with hormone replacement. Reprod Med Biol 2019; 18:290-295. [PMID: 31312109 PMCID: PMC6613020 DOI: 10.1002/rmb2.12274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 03/27/2019] [Accepted: 04/22/2019] [Indexed: 11/06/2022] Open
Abstract
PURPOSE The clinical utility of chlormadinone acetate tablets (Lutoral™), an orally active progestin which has been available since June 2007, was compared to an in-house vaginal suppository formulation of progesterone used between 2006 and 2007 for assisted reproductive technology (ART). METHODS We retrospectively evaluated the efficacy and safety of chlormadinone acetate by comparing the pregnancy rates and the incidences of birth defects and hypospadias in frozen-thawed embryo transfer cycles using the in-house vaginal progesterone and those using chlormadinone acetate for luteal phase support. RESULTS The pregnancy rates in the frozen-thawed embryo transfer cycles were 31.2% (259/831) with vaginal progesterone for luteal phase support and 31.6% (4228/13 381) with chlormadinone acetate (no significant difference). In the cycles resulting in live birth following administration of chlormadinone acetate between July 2007 and December 2015, the incidence of birth defects was 2.8% (80/2893), and the incidence of hypospadias was 0.03% (1/2893). CONCLUSIONS These results indicate that the pregnancy rate following frozen-thawed embryo transfer using chlormadinone acetate for luteal phase support was comparable with that using vaginal progesterone, with no increased risk of birth defects, including hypospadias, which has been a concern following the use of progestins.
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Affiliation(s)
- Yoshimasa Asada
- Asada Ladies ClinicNagoyaJapan
- Asada Institute for Reproductive MedicineKasugaiJapan
| | | | | | | | - Rie Ito
- Asada Ladies ClinicNagoyaJapan
| | - Noritaka Fukunaga
- Asada Ladies ClinicNagoyaJapan
- Asada Institute for Reproductive MedicineKasugaiJapan
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Chau LTM, Tu DK, Lehert P, Dung DV, Thanh LQ, Tuan VM. Clinical pregnancy following GnRH agonist administration in the luteal phase of fresh or frozen assisted reproductive technology (ART) cycles: Systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol X 2019; 3:100046. [PMID: 31403130 PMCID: PMC6687475 DOI: 10.1016/j.eurox.2019.100046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 04/25/2019] [Accepted: 05/10/2019] [Indexed: 11/19/2022] Open
Abstract
Objective(s) To study if the GnRH agonist administration in luteal phase improves clinical pregnancy rate of fresh and frozen embryo transfer. Also, this meta-analysis compares the treatment effect of luteal GnRH agonist administration between long agonist and antagonist protocols of fresh cycles, and between two types of treatment: fresh and frozen embryo transfers. Study design Systematic review and meta-analysis (registration number CRD42017059152) Results For the overall 20 studies (5497 patients), clinical pregnancy rate significantly increased in group of GnRH agonist administration compared to control group (RR 1.24, 95% CI 1.14–1.34, p < 0.0001). Regarding the treatment effect of luteal GnRH agonist administration between long agonist and antagonist protocol fresh cycles, no significant difference was observed (RR = 1.28, 95% CI 0.98–1.67, p = 0.07). Also, in comparison between fresh and frozen embryo transfer, similar effect of GnRH agonist administration was found (RR = 0.93, 95% CI 0.74–1.16, p = 0.49). Conclusion(s) There is evidence that GnRH agonist administration in luteal phase improve clinical pregnancy rate in both fresh and frozen cycles. Within fresh cycles, no significant difference of clinical pregnancy rate is found between two protocols. In frozen cycles, the effect of GnRH agonist administration in enhancing clinical pregnancy rate is similar to fresh cycles.
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Affiliation(s)
- Le Thi Minh Chau
- Department of Infertility, Tu Du hospital, Vietnam
- Corresponding author at: Tu Du hospital.
| | | | - Philippe Lehert
- Faculty of Medicine, the University of Melbourne, Australia
- Faculty of Economics, UCL Mons, Louvain, Belgium
| | - Do Van Dung
- University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | | | - Vo Minh Tuan
- University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
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6
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Kasapoglu I, Düzok N, Şen E, Çakır C, Avcı B, Uncu G. Luteal oestradiol for patients with serum oestradiol levels lower than expected per oocyte. HUM FERTIL 2019; 24:122-128. [PMID: 30694077 DOI: 10.1080/14647273.2019.1566647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Although the efficiency of progesterone in providing luteal phase support has been established, the role of oestradiol supplementation during the luteal phase remains controversial. We evaluated pregnancy outcomes of patients who had a ratio of serum E2 levels on the hCG day to the number of oocytes retrieved (oestradiol/oocyte ratio - EOR) levels of <100 pg/ml by supporting them with additional oestradiol during the luteal phase. In total, 150 patients with an EOR < 100 pg/ml of oestradiol undergoing antagonist intracytoplasmic sperm injection (ICSI) cycles were randomly assigned into two groups to receive either oral oestradiol (4 mg/d) plus vaginal progesterone (90 mg, 2 × 1/day) (group 1) or vaginal progesterone (90 mg, 2 × 1/d) alone (group 2). Implantation rate following transfer of a single embryo did not differ between the two groups (group 1 = 33.3%; group 2 = 34.9%; p = 0.85). Similarly, both groups gave comparable clinical pregnancy rates per embryo transfer with 31.7% in group 1 compared with 28.6% in group 2 (p = 0.69). In conclusion the study suggests that the addition of 4 mg oral E2 to progesterone does not increase the probability of pregnancy.
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Affiliation(s)
- Isıl Kasapoglu
- Department of Obstetrics and Gynecology, Uludag University School of Medicine, Bursa, Turkish Republic
| | - Nergis Düzok
- Department of Obstetrics and Gynecology, Uludag University School of Medicine, Bursa, Turkish Republic
| | - Esra Şen
- Department of Histology and Embryology, Uludag University School of Medicine, Bursa, Turkish Republic
| | - Cihan Çakır
- Department of Histology and Embryology, Uludag University School of Medicine, Bursa, Turkish Republic
| | - Berrin Avcı
- Department of Histology and Embryology, Uludag University School of Medicine, Bursa, Turkish Republic
| | - Gürkan Uncu
- Department of Obstetrics and Gynecology, Uludag University School of Medicine, Bursa, Turkish Republic
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7
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Saravelos SH, Li TC. Embryo transfer techniques. Best Pract Res Clin Obstet Gynaecol 2019; 59:77-88. [PMID: 30711373 DOI: 10.1016/j.bpobgyn.2019.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 01/03/2019] [Accepted: 01/07/2019] [Indexed: 10/27/2022]
Abstract
Embryo transfer is the final and rate-limiting step of the assisted reproductive technique. Few advances have occurred in the last few decades with regard to this procedure. Studies conducted thus far have focused on factors and interventions taking place before, during and after this procedure. These factors are highly varied and range from methods to improve the psychological state of the patients to methods aimed at reducing uterine contractility and methods aimed at optimising the precise transfer of the embryo. The key question is which factors and interventions have thus far been proven to increase pregnancy rates and live birth rates. This paper aims to review the evidence relating to embryo transfer techniques in a systematic manner with a view to provide practical recommendations to practitioners involved in the procedure.
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Affiliation(s)
| | - Tin-Chiu Li
- Assisted Reproductive Technology Unit, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
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8
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Venturella R, Vaiarelli A, Buffo L, D'alessandro P, Colamaria S, Pedri S, Di Carlo C, Alviggi E, Forte M, Faustini F, Zullo F, Rienzi L, Ubaldi FM. Progesterone for preparation of the endometrium for frozen-thawed blastocyst transfer in vitro fertilization cycles: a prospective study on patients' opinions on a new subcutaneous formulation. Gynecol Endocrinol 2018; 34:766-771. [PMID: 29546775 DOI: 10.1080/09513590.2018.1451508] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
We aimed to evaluate patients' perspectives on a progesterone subcutaneous formulation for endometrial preparation for frozen-thawed blastocyst transfer. In this prospective study, women with at least one experience with vaginal progesterone, undergone endometrial preparation with oral estradiol valerate and daily subcutaneous progesterone administered from the fifth day before the transfer until the day of the beta-hCG test. Patients completed three questionnaires, at enrollment (Q1), for gathering information on the experience with vaginal treatment and expectations about the subcutaneous route and then at the time of the transfer (Q2) and eight days later (Q3). Main outcome measures were patients' opinions on comfort, ease of use, convenience, overall satisfaction, level of anxiety and pain associated with the administration of subcutaneous progesterone in comparison with their previous experience. Sixty-nine women completed the questionnaires. All vaginal versus subcutaneous comparisons were significantly in favor of the subcutaneous route. When comparing patients' expectations at Q1 with patients' opinions at Q2 and Q3, all evaluations, except for one, demonstrated that the patient's positive expectation was confirmed after 5 and 13 days of treatment. In conclusion, in women with previous experience with vaginal progesterone, the subcutaneous route was associated with significantly increased acceptance.
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Affiliation(s)
- Roberta Venturella
- a Department of Obstetrics and Gynaecology , Magna Graecia University of Catanzaro , Catanzaro , Italy
- b GENERA Napoli, Clinica Ruesch , Naples , Italy
| | - Alberto Vaiarelli
- c GENERA Roma, Clinica Valle Giulia , Rome , Italy
- d Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi" , University of Messina , Messina , Italy
| | - Laura Buffo
- e GENERA Marostica, Poliambulatorio SALUS , Marostica , Italy
| | | | | | - Sara Pedri
- a Department of Obstetrics and Gynaecology , Magna Graecia University of Catanzaro , Catanzaro , Italy
| | - Costantino Di Carlo
- a Department of Obstetrics and Gynaecology , Magna Graecia University of Catanzaro , Catanzaro , Italy
| | | | - Marina Forte
- c GENERA Roma, Clinica Valle Giulia , Rome , Italy
| | | | - Fulvio Zullo
- a Department of Obstetrics and Gynaecology , Magna Graecia University of Catanzaro , Catanzaro , Italy
| | - Laura Rienzi
- b GENERA Napoli, Clinica Ruesch , Naples , Italy
- c GENERA Roma, Clinica Valle Giulia , Rome , Italy
- d Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi" , University of Messina , Messina , Italy
| | - Flippo M Ubaldi
- b GENERA Napoli, Clinica Ruesch , Naples , Italy
- c GENERA Roma, Clinica Valle Giulia , Rome , Italy
- d Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi" , University of Messina , Messina , Italy
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Enatsu Y, Enatsu N, Kishi K, Iwasaki T, Matsumoto Y, Kokeguchi S, Shiotani M. Effectiveness of high-dose transvaginal progesterone supplementation for women who are undergoing a frozen-thawed embryo transfer. Reprod Med Biol 2018; 17:242-248. [PMID: 30013424 PMCID: PMC6046522 DOI: 10.1002/rmb2.12096] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 02/05/2018] [Indexed: 01/21/2023] Open
Abstract
PURPOSE To evaluate the effectiveness of high-dose progesterone supplementation for women who are undergoing a frozen-thawed embryo transfer (FET). METHODS Among the 2010 FET cycles that were included in the present study, 1188 were 1200 mg/d of vaginal progesterone, while 822 were 900 mg/d. The dose of progesterone that was used was decided by the treatment period and additional progesterone supplementation was used when the serum progesterone levels were <9 ng/mL on luteal day 5. RESULTS The clinical pregnancy rate was higher in the 1200 mg group than in the 900 mg group. The mean serum progesterone level on luteal day 5 in the 1200 mg and 900 mg groups was 12.6 ng/mL and 13.4 ng/mL, respectively. The rate of additional progesterone supplementation was higher in the 1200 mg group. A logistic regression analysis identified a younger age (≤37 years) and the use of 1200 mg progesterone as independent predictive factors for the clinical pregnancy outcome. The analysis of the infant outcomes revealed no significant difference in the distribution of birth ages and weights. CONCLUSION High-dose transvaginal progesterone of 1200 mg/d as luteal support contributed to good pregnancy outcomes.
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Abstract
Progestational agents are often prescribed to prevent pregnancy loss. Progestogens affect implantation, cytokine balance, natural killer cell activity, arachidonic acid release and myometrial contractility. Progestogens have therefore been used at all stages of pregnancy including luteal-phase support prior to pregnancy, threatened miscarriage, recurrent miscarriage, and to prevent preterm labor. In luteal support, a Cochrane review reported that progestogens were associated with a higher rate of live births or ongoing pregnancy in the progesterone group (odds ratio 1.77, 95% confidence interval (CI) 1.09-2.86). Evidence suggests that progestogens are also effective for treating threatened miscarriage. Again, in a Cochrane Database review, progestogens were associated with a reduced odds ratio of 0.53 (95% CI 0.35-0.79) when progestogens were used. In recurrent miscarriage, progestogens also seem to have a beneficial effect. A meta-analysis of progestational agents showed a 28% increase in the live birth rate (relative risk 0.72, 95% CI 0.53-0.97). For the last 30 years, progestogens have been used to prevent preterm labor. Recent meta-analyses also report beneficial effects. This review summarizes the literature and the author's experience using progestogens to prevent pregnancy loss.
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Affiliation(s)
- H J A Carp
- a Department of Obstetrics & Gynecology , Sheba Medical Center , Tel Hashomer , Israel
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Xie B, Liu Y, Guo Y, Zhang E, Pu C, He H, Yin T, Tang X. Progesterone PLGA/mPEG-PLGA Hybrid Nanoparticle Sustained-Release System by Intramuscular Injection. Pharm Res 2018; 35:62. [PMID: 29445971 DOI: 10.1007/s11095-018-2357-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 01/31/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE To prepare sustained-release PLGA/mPEG-PLGA hybrid nanoparticles of progesterone (PRG), and evaluate the descending required administration dosage in vivo. METHODS PRG hybrid nanoparticles (PRG H-NPs) based on PLGA/mPEG-PLGA were compared with PRG nanoparticles (PRG-NPs) of pure PLGA as the matrix and PRG-oil solutions. Nanoparticles (NPs) were formed by the method of nanoemulsion, and the pharmacokinetics of the sustained-release PRG H-NPs in male Sprague dawley (SD) rats were investigated. The rats were randomly divided into four groups, each group received: single dose of PRG H-NPs (14.58 mg/kg, i.m.) and PRG-NPs (14.58 mg/kg, i.m.), repeated dosing for 7 days of PRG-oil (2.08 mg/kg, i.m.) solution (Oil-L) and a higher dosage of PRG-oil (6.24 mg/kg, i.m.) solution (Oil-H), respectively. RESULTS In the pharmacokinetic test, the PRG H-NPs exhibited a comparatively good sustained-release effect against the PRG-NPs without mPEG-PLGA and PRG-oil solution. The pharmacokinetic parameters of the PRG H-NPs, PRG-NPs, Oil-L and Oil-H were AUC0-t(ng·h·mL-1) 8762.1, 1546.1, 1914.5, and 12,138.9, t1/2 (h)52.7, 44.1, 8.4 and 44.6 respectively. CONCLUSIONS Owing to the modification of PEG, PRG H-NPs can act as safe delivery platforms for sustained-release of drugs with a lower dosage required.
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Affiliation(s)
- Bin Xie
- School of Pharmacy, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenyang, 110016, China
| | - Yang Liu
- School of Pharmacy, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenyang, 110016, China
| | - Yuting Guo
- School of Pharmacy, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenyang, 110016, China
| | - Enbo Zhang
- School of Pharmacy, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenyang, 110016, China
| | - Chenguang Pu
- School of Pharmacy, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenyang, 110016, China
| | - Haibing He
- School of Pharmacy, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenyang, 110016, China
| | - Tian Yin
- School of Pharmacy, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenyang, 110016, China
| | - Xing Tang
- School of Pharmacy, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenyang, 110016, China.
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Ismail Madkour WA, Noah B, Abdel Hamid AMS, Zaheer H, Al-Bahr A, Shaeer M, Moawad A. Luteal phase support with estradiol and progesterone versus progesterone alone in GnRH antagonist ICSI cycles: a randomized controlled study. HUM FERTIL 2018; 19:142-9. [PMID: 27434094 DOI: 10.1080/14647273.2016.1200145] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In vitro fertilization (IVF) cycles are associated with a defective luteal phase. Although progesterone supplementation to treat this problem is standard practice, estrogen addition is debatable. Our aim was to compare pregnancy outcomes in 220 patients undergoing antagonist intracytoplasmic sperm injection (ICSI) cycles protocol. The patients were randomly assigned into two equal groups to receive either vaginal progesterone alone (90 mg once daily) starting on the day of oocyte retrieval for up to 12 weeks if pregnancy occurred or estradiol addition (2 mg twice daily) starting on the same day and continuing up to seven weeks (foetal viability scan). Primary outcomes were pregnancy and ongoing pregnancy rates per embryo transfer. Secondary outcomes were implantation and early pregnancy loss rates. Pregnancy rates showed no significant difference between group 1 (39.09%) and 2 (43.63%) (p value = 0.3). Similarly, both groups were comparable regarding ongoing pregnancy rate (32.7% group 1 and 36.3% group 2, p value = 0.1). Implantation rates showed no difference between group 1 (19.25%) and group 2 (23.44%) (p value = 0.2). Early pregnancy loss rates were comparable, with 6.3% and 7.2% in groups 1 and 2, respectively, (p value = 0.4). In conclusion, the addition of 4 mg estrogen daily to progesterone for luteal support in antagonist ICSI cycles is not beneficial for pregnancy outcome.
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Affiliation(s)
- Wael A Ismail Madkour
- a Obstetrics and Gynecology Department , Ain-Shams University , Cairo , Egypt ;,b Dubai Gynecology and Fertility Centre , Dubai , UAE
| | - Bassel Noah
- b Dubai Gynecology and Fertility Centre , Dubai , UAE
| | - Amr M S Abdel Hamid
- a Obstetrics and Gynecology Department , Ain-Shams University , Cairo , Egypt ;,c IVF Unit , Enjab Hospital , Sharjah , UAE
| | - Hena Zaheer
- b Dubai Gynecology and Fertility Centre , Dubai , UAE
| | | | | | - Ashraf Moawad
- c IVF Unit , Enjab Hospital , Sharjah , UAE ;,d Obstetrics and Gynecology Department, Al-Azhar University , Cairo , Egypt
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Effect of the initiation of progesterone supplementation in in vitro fertilization-embryo transfer outcomes: a prospective randomized controlled trial. Fertil Steril 2017; 109:97-103. [PMID: 29175065 DOI: 10.1016/j.fertnstert.2017.09.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 09/14/2017] [Accepted: 09/26/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To analyze the influence of the start point of luteal support on clinical pregnancy rate, implantation rate, and live birth rate of in vitro fertilization and embryo transfer (IVF-ET) cycles. DESIGN Single-center prospective randomized controlled trial. SETTING University-affiliated IVF unit. PATIENT(S) Women ≤35 years of age with day 3 FSH levels <15 mIU/mL, who were undergoing their first IVF-ET cycles and received ovarian stimulation with the use of a GnRH agonist long protocol. INTERVENTION(S) The patients were randomized on the day of hCG trigger to receive luteal phase support either 1 day after oocyte retrieval (group A) or on the day of oocyte retrieval (group B). MAIN OUTCOME MEASURE(S) Clinical pregnancy rate, implantation rate, miscarriage rate in the first trimester of pregnancy, and live birth rate per embryo transfer cycle. RESULT(S) Two hundred thirty-three patients were enrolled in this study: 117 were assigned to group A and 116 to group B. The clinical pregnancy rate (group A vs. group B: 55.3% vs. 51.5%), implantation rate (38.4% vs. 38.0%), and miscarriage rate (7.7% vs. 7.5%) were similar between the two groups. The live birth rate also did not significantly differ between the two groups (45.7% vs. 46.6%). CONCLUSION(S) Our study indicated that the initiation of progesterone supplementation 1 day after oocyte retrieval did not decrease the clinical pregnancy rate, implantation rate, or live birth rate in women undergoing IVF-ET cycles with the use of the GnRH agonist long protocol. CLINICAL TRIAL REGISTRATION NUMBER ChiCTR-IPR-14005293.
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Aslih N, Ellenbogen A, Shavit T, Michaeli M, Yakobi D, Shalom-Paz E. Can we alter pregnancy outcome by adjusting progesterone treatment at mid-luteal phase: a randomized controlled trial. Gynecol Endocrinol 2017; 33:602-606. [PMID: 28277886 DOI: 10.1080/09513590.2017.1298742] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Our study aimed to determine whether mid-luteal serum P concentrations can serve as a predictive factor for in vitro fertilization (IVF) outcomes and whether increasing P dosage for patients with low levels at mid-luteal phase may improve pregnancy rates. It was a prospective, randomized controlled study. A total of 146 patients undergoing IVF treatment were prospectively enrolled and received routine luteal phase support (LPS) regimen of Endometrin® (progesterone) 200 mg/day. Serum P levels were measured 7 days after embryo transfer (ET). Considering a cutoff level of 15 ng/ml on this day, patients with higher levels continued the same dosage until pregnancy test (control group). Patients with lower levels were randomly allocated to continue Endometrin® 200 mg/day (Group A) or to increase Endometrin® dosage to 300 mg/day (Group B). The Main Outcome Measures were pregnancy rates. Both biochemical and clinical pregnancy and live birth rates were comparable between all groups regardless of P level on day 7 of luteal phase and regardless of dose adjustment. ROC analysis determined that mid-luteal P levels of 17 ng/ml can be a better predictor of cycle outcome. In conclusion raising the P dose at mid-luteal phase to 300 mg daily did not improve cycle outcomes.
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Affiliation(s)
- Nardin Aslih
- a IVF Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Hillel Yaffe Medical Center, The Technion-Israel Institute of Technology , Hadera , Israel
| | - Adrian Ellenbogen
- a IVF Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Hillel Yaffe Medical Center, The Technion-Israel Institute of Technology , Hadera , Israel
| | - Tal Shavit
- a IVF Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Hillel Yaffe Medical Center, The Technion-Israel Institute of Technology , Hadera , Israel
| | - Medeia Michaeli
- a IVF Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Hillel Yaffe Medical Center, The Technion-Israel Institute of Technology , Hadera , Israel
| | - Devora Yakobi
- a IVF Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Hillel Yaffe Medical Center, The Technion-Israel Institute of Technology , Hadera , Israel
| | - Einat Shalom-Paz
- a IVF Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Hillel Yaffe Medical Center, The Technion-Israel Institute of Technology , Hadera , Israel
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Shiotani M, Matsumoto Y, Okamoto E, Yamada S, Mizusawa Y, Furuhashi K, Ogata H, Ogata S, Kokeguchi S. Is human chorionic gonadotropin supplementation beneficial for frozen and thawed embryo transfer in estrogen/progesterone replacement cycles?: A randomized clinical trial. Reprod Med Biol 2017; 16:166-169. [PMID: 29259465 PMCID: PMC5661815 DOI: 10.1002/rmb2.12023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 01/07/2017] [Indexed: 11/10/2022] Open
Abstract
Aim Human chorionic gonadotropin (hCG) is used frequently for luteal support in fresh in vitro fertilization cycles as it induces progesterone secretion from the ovaries after oocyte retrieval and modulates the endometrium for implantation in fresh cycles. In contrast, hCG is not usually used for the transfer of cryopreserved-thawed embryos in estrogen/progesterone replacement cycles because ovulation is suppressed. However, several studies have shown that luteinizing hormone and hCG receptors are present in the human endometrium and that hCG can directly induce the decidualization of endometrial stromal cells in vitro. Thus, this study evaluated whether hCG supplementation can be beneficial for cryopreserved-thawed embryo transfer in estrogen/progesterone replacement cycles. Methods One-hundred-and seventy-three cryopreserved-thawed embryo transfer cycles with estrogen/progesterone replacement were divided randomly into two groups. Transdermal oestradiol was used in combination with vaginal progesterone suppositories for HR. The embryo transfer was performed on day 17 and/or day 20 of the HR therapy cycle in both groups. In Group A, 3000 IU of hCG was administered on days 17, 20, and 23. In Group B, hCG was not used. Results There was no significant difference in the average age of the patients, the average number of previous assisted reproductive technology cycles, or the average number of embryo transfers between the two groups. The rates of pregnancy and implantation per embryo were 37.2% and 25.3%, respectively, in Group A and 35.6% and 21.7%, respectively, in Group B. The pregnancy and implantation rates were similar in both groups. Conclusion Supplementation with hCG is not beneficial for cryopreserved-thawed embryo transfer in estrogen/progesterone replacement cycles.
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Cometti B. Pharmaceutical and clinical development of a novel progesterone formulation. Acta Obstet Gynecol Scand 2016; 94 Suppl 161:28-37. [PMID: 26342177 DOI: 10.1111/aogs.12765] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 08/31/2015] [Indexed: 11/30/2022]
Abstract
Progesterone plays an essential role in reproductive events. Its use for luteal support in patients undergoing infertility treatment is an established practice. The different routes used to administer progesterone impact on its efficacy in luteal support: oral administration has been shown to be ineffective due to an extensive first-pass metabolism in the liver; vaginal application has a good efficacy but has drawbacks such as vaginal leakage, irritation, discomfort and uncertainty about the real dose adsorbed; finally, intramuscular administration ensures a precise dosage but can be extremely painful with, in some cases, formation of sterile abscesses. A new progesterone preparation is now available in several European and extra-European countries that combines the precise dosage of the injectable formulation with the comfort of a well-tolerated subcutaneous self-administration. The pharmacokinetic and pharmacodynamic properties of this new product are reviewed here, together with the clinical evidence obtained in two multicenter randomized clinical trials.
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Affiliation(s)
- Barbara Cometti
- Research & Development Department, IBSA Institut Biochimique SA, Pambio-Noranco, Switzerland
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17
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Fujiwara T. A multi-center, randomized, open-label, parallel group study of a natural micronized progesterone vaginal tablet as a luteal support agent in Japanese women undergoing assisted reproductive technology. Reprod Med Biol 2015; 14:185-193. [PMID: 26457065 PMCID: PMC4592497 DOI: 10.1007/s12522-015-0211-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 05/20/2015] [Indexed: 11/25/2022] Open
Abstract
Purpose To verify sufficient progesterone supplementation during the luteal phase and to determine the efficacy and safety of a natural micronized progesterone vaginal tablet (FE 999913) in Japanese women undergoing in vitro fertilization‐embryo transfer or intracytoplasmic sperm injection. Methods In a multi‐center, randomized, open‐label, parallel group trial, 108 subjects were randomized to receive FE 999913 vaginally twice daily (n = 54) or three times daily (n = 54) for up to 10 weeks. Primary endpoints were the proportion of subjects with serum progesterone concentration ≥10 ng/ml on day 5 and ongoing pregnancy rate at week 5. Results Ninety‐four subjects completed the trial and 90 subjects underwent embryo transfer. The proportion of subjects with serum progesterone concentration ≥10 ng/ml on day 5 was 98.9 % and the lower limit of 95 % CI of the difference between the current trial and MEGASET trial was −3.6 %, which was within the non‐inferiority criterion. The ongoing pregnancy rate was 22.2 %, which is similar to that in actual clinical settings in Japan. No safety concerns were observed. Conclusions FE 999913 was useful in this trial from the aspects of sufficient supplementation of progesterone, comparable pregnancy rate with that in clinical practice in Japan, and safety. Clinical trial registration ClinicalTrials.gov identifier: NCT01710514.
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Affiliation(s)
- Toshihiro Fujiwara
- Center for Human Reproduction and Gynecologic Endoscopy, Sanno HospitalInternational University of Health and Welfare8‐10‐16 Akasaka, Minato‐ku107‐0052TokyoJapan
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Şimşek E, Kılıçdağ EB, Aytaç PÇ, Çoban G, Şimşek SY, Çok T, Haydardedeoğlu B. Addition of gonadotropin releasing hormone agonist for luteal phase support in in-vitro fertilization: an analysis of 2739 cycles. J Turk Ger Gynecol Assoc 2015; 16:96-101. [PMID: 26097392 DOI: 10.5152/jtgga.2015.15007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 04/06/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Luteal phase is defective in in vitro fertilization (IVF) cycles, and many regimens were tried for the very best luteal phase support (LPS). Gonadotropin releasing hormone (GnRH) agonist use, which was administered as an adjunct to the luteal phase support in IVF cycles, was suggested to improve pregnancy outcome measures in certain randomized studies. We analyzed the effects of addition of GnRH agonist to standard progesterone luteal support on pregnancy outcome measures, particularly the live birth rates. MATERIAL AND METHODS This is a retrospective cohort study, including 2739 IVF cycles. Long GnRH agonist and antagonist stimulation IVF cycles with cleavage-stage embryo transfer were included. Cycles were divided into two groups: Group A included cycles with single-dose GnRH agonist plus progesterone LPS and Group B included progesterone only LPS. Live birth rates were the primary outcome measures of the analysis. Miscarriage rates and multiple pregnancy rates were the secondary outcome measures. RESULTS Live birth rates were not statistically different in GnRH agonist plus progesterone (Group A) and progesterone only (Group B) groups in both the long agonist and antagonist stimulation arms (40.8%/41.2% and 32.8%/34.4%, p<0.05 respectively). Moreover, pregnancy rates, implantation rates, and miscarriage rates were found to be similar between groups. Multiple pregnancy rates in antagonist cycles were significantly higher in Group A than those in Group B (12.0% and 6.9%, respectively). CONCLUSION A beneficial effect of a single dose of GnRH agonist administration as a luteal phase supporting agent is yet to be determined because of the wide heterogeneity of data present in literature. Well-designed randomized clinical studies are required to clarify any effect of luteal GnRH agonist addition on pregnancy outcome measures with different doses, timing, and administration routes of GnRH agonists.
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Affiliation(s)
- Erhan Şimşek
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and IVF Unit, Başkent University Faculty of Medicine Adana Hospital, Adana, Turkey
| | - Esra Bulgan Kılıçdağ
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and IVF Unit, Başkent University Faculty of Medicine Adana Hospital, Adana, Turkey
| | - Pınar Çağlar Aytaç
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and IVF Unit, Başkent University Faculty of Medicine Adana Hospital, Adana, Turkey
| | - Gonca Çoban
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and IVF Unit, Başkent University Faculty of Medicine Adana Hospital, Adana, Turkey
| | - Seda Yüksel Şimşek
- Department of Obstetrics and Gynecology, Adana Maternity Hospital, Adana, Turkey
| | - Tayfun Çok
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and IVF Unit, Başkent University Faculty of Medicine Adana Hospital, Adana, Turkey
| | - Bülent Haydardedeoğlu
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and IVF Unit, Başkent University Faculty of Medicine Adana Hospital, Adana, Turkey
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Connell MT, Szatkowski JM, Terry N, DeCherney AH, Propst AM, Hill MJ. Timing luteal support in assisted reproductive technology: a systematic review. Fertil Steril 2015; 103:939-946.e3. [PMID: 25638420 DOI: 10.1016/j.fertnstert.2014.12.125] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 12/10/2014] [Accepted: 12/30/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To summarize the available published randomized controlled trial data regarding timing of P supplementation during the luteal phase of patients undergoing assisted reproductive technology (ART). DESIGN A systematic review. SETTING Not applicable. PATIENT(S) Undergoing IVF. INTERVENTION(S) Different starting times of P for luteal support. MAIN OUTCOME MEASURE(S) Clinical pregnancy (PR) and live birth rates. RESULT(S) Five randomized controlled trials were identified that met inclusion criteria with a total of 872 patients. A planned meta-analysis was not performed because of a high degree of clinical heterogeneity with regard to the timing, dose, and route of P. Two studies compared P initiated before oocyte retrieval versus the day of oocyte retrieval and PRs were 5%-12% higher when starting P on the day of oocyte retrieval. One study compared starting P on day 6 after retrieval versus day 3, reporting a 16% decrease in pregnancy in the day 6 group. Trials comparing P start times on the day of oocyte retrieval versus 2 or 3 days after retrieval showed no significant differences in pregnancy. CONCLUSION(S) There appears to be a window for P start time between the evening of oocyte retrieval and day 3 after oocyte retrieval. Although some studies have suggested a potential benefit in delaying vaginal P start time to 2 days after oocyte retrieval, this review could not find randomized controlled trials to adequately assess this. Further randomized clinical trials are needed to better define P start time for luteal support after ART.
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Affiliation(s)
- Matthew T Connell
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Jennifer M Szatkowski
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Nancy Terry
- National Institutes of Health Library, Bethesda, Maryland
| | - Alan H DeCherney
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | | | - Micah J Hill
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.
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20
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Recommended practices for the management of embryology, andrology, and endocrinology laboratories: a committee opinion. Fertil Steril 2014; 102:960-3. [DOI: 10.1016/j.fertnstert.2014.06.036] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 06/20/2014] [Indexed: 11/25/2022]
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Kutlusoy F, Guler I, Erdem M, Erdem A, Bozkurt N, Biberoglu EH, Biberoglu KO. Luteal phase support with estrogen in addition to progesterone increases pregnancy rates in in vitro fertilization cycles with poor response to gonadotropins. Gynecol Endocrinol 2014; 30:363-6. [PMID: 24517720 DOI: 10.3109/09513590.2014.887065] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In this study, our objective was to determine the effect of adding estradiol hemihydrate (E2) to progestin (P) for luteal phase support on pregnancy outcome in in vitro fertilization (IVF) cycles with poor response to gonadotropins. Ninety-five women with poor ovarian response who underwent controlled ovarian hyperstimulation (COH) with gonadotropin releasing hormone (GnRH) agonist or GnRH antagonist plus gonadotropin protocol for IVF were prospectively randomized into three groups of luteal phase support after oocyte retrieval. Group 1 (n = 33) received only intravaginal progesterone gel (Crinone 8% gel). Group 2 (n = 27) and Group 3 (n = 35) received intravaginal progesterone plus oral 2 and 6 mg estradiol hemihydrate, respectively. Main outcome measures were overall and clinical pregnancy rates (PRs) per patient. Serum LH, E2 and P levels at 7th and 14th days of luteal phase were also measured. Overall and clinical PRs were significantly higher in 2 mg E2 + P than P-only group (44% versus 18% and 37% versus 12.1%, respectively). There were no statistically significant differences between 6 mg E2 + P versus P-only and 2 mg E2 + P versus 6 mg E2 + P groups regarding PRs. Addition of 2 mg/day E2 in addition to P for luteal support significantly increase overall and clinical PRs in cycles with poor response to gonadotropins after IVF.
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Affiliation(s)
- Fatma Kutlusoy
- Department of Obstetrics & Gynecology, Gazi University School of Medicine , Ankara , Turkey and
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Mainigi MA, Olalere D, Burd I, Sapienza C, Bartolomei M, Coutifaris C. Peri-implantation hormonal milieu: elucidating mechanisms of abnormal placentation and fetal growth. Biol Reprod 2014; 90:26. [PMID: 24352558 DOI: 10.1095/biolreprod.113.110411] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Assisted reproductive technologies (ART) have been associated with several adverse perinatal outcomes involving placentation and fetal growth. It is critical to examine each intervention individually in order to assess its relationship to the described adverse perinatal outcomes. One intervention ubiquitously used in ART is superovulation with gonadotropins. Superovulation results in significant changes in the hormonal milieu, which persist during the peri-implantation and early placentation periods. Epidemiologic evidence suggests that the treatment-induced peri-implantation maternal environment plays a critical role in perinatal outcomes. In this study, using the mouse model, we have isolated the exposure to the peri-implantation period, and we examine the effect of superovulation on placentation and fetal growth. We report that the nonphysiologic peri-implantation maternal hormonal environment resulting from gonadotropin stimulation appears to have a direct effect on fetal growth, trophoblast differentiation, and gene expression. This appears to be mediated, at least in part, through trophoblast expansion and invasion. Although the specific molecular and cellular mechanism(s) leading to these observations remain to be elucidated, identifying this modifiable risk factor will not only allow us to improve perinatal outcomes with ART, but help us understand the pathophysiology contributing to these outcomes.
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Affiliation(s)
- Monica A Mainigi
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania
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23
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Feinberg EC, Beltsos AN, Nicolaou E, Marut EL, Uhler ML. Endometrin as luteal phase support in assisted reproduction. Fertil Steril 2012; 99:174-178.e1. [PMID: 23137759 DOI: 10.1016/j.fertnstert.2012.09.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 09/10/2012] [Accepted: 09/13/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare clinical pregnancy rate (PR) and live birth rate (LBR) between Endometrin monotherapy versus Endometrin and P in oil combination therapy in assisted reproductive technology (ART) cycles. DESIGN Retrospective analysis. SETTING Large private practice. PATIENT(S) Patients undergoing autologous fresh IVF cycles, autologous frozen ET cycles, and fresh oocyte donor cycles were included for analysis. INTERVENTION(S) Endometrin as a single agent for luteal support, Endometrin monotherapy or Endometrin with P in oil used at least once every 3 days for luteal support, Endometrin combination therapy. MAIN OUTCOME MEASURE(S) Clinical PR and LBR. RESULT(S) A total of 1,034 ART cycles were analyzed. Endometrin monotherapy was used in 694 of 1,034 (67%) cycles and Endometrin combination therapy was used in 340 of 1,034 (33%) cycles. In all fresh cycles, clinical PR was not significantly different (IVF autologous: Endometrin monotherapy 46.9% vs. Endometrin combination therapy 55.6%; donor oocyte endometrin monotherapy 45.2% vs. Endometrin combination therapy 52.0%). Frozen ET cycles had a significantly higher clinical PR and LBR with combination therapy group compared with monotherapy (clinical PR 47.9% vs. 23.5%; LBR 37.5% vs. 17.3%). CONCLUSION(S) Endometrin monotherapy was sufficient for the P component of luteal support and provided high PRs for fresh cycles in both autologous and donor oocyte cycles. Clinical PR and LBR in frozen ET cycles were significantly improved with the addition of IM P to Endometrin therapy. This may reflect the fact that lesser quality embryos are transferred in frozen ET cycles, and more intense P support is required for comparable PRs.
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Affiliation(s)
| | | | - Elitsa Nicolaou
- Michigan State University, College of Human Medicine, East Lansing, Michigan
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Agha-Hosseini M, Rahmani M, Alleyassin A, Safdarian L, Sarvi F. The effect of progesterone supplementation on pregnancy rates in controlled ovarian stimulation and intrauterine insemination cycles: a randomized prospective trial. Eur J Obstet Gynecol Reprod Biol 2012; 165:249-53. [PMID: 22940119 DOI: 10.1016/j.ejogrb.2012.08.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Revised: 07/13/2012] [Accepted: 08/05/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To evaluate the effect of vaginal progesterone as luteal phase support on pregnancy rates in controlled ovarian stimulation and intrauterine insemination cycles in couples with unexplained or mild male factor infertility. STUDY DESIGN 290 Patients who met the inclusion criteria were included in a prospective randomized controlled trial. All patients underwent controlled ovarian stimulation and intrauterine insemination: 148 patients were randomized to start with a supported cycle and 142 patients with an unsupported cycle. In supported cycles, patients received vaginal progesterone once daily from the day after insemination until 12 weeks of pregnancy or, in non-pregnant women, for 14 days. No progesterone was given during unsupported cycles. The main outcome measures were clinical pregnancy rates per cycle. RESULTS In total, 148 cycles with luteal phase support and 142 cycles without luteal phase support were performed. The clinical pregnancy rates per cycle were higher for cycles with luteal phase support than for the unsupported cycles (24.3% vs. 14.1% respectively, p=0.027). CONCLUSION The use of vaginal suppositories as luteal phase support significantly improved clinical pregnancy rates in controlled ovarian stimulation and intrauterine insemination in patients with unexplained or mild male factor infertility.
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Affiliation(s)
- Marzieh Agha-Hosseini
- Infertility Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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25
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Aghsa MM, Rahmanpour H, Bagheri M, Davari-Tanha F, Nasr R. A randomized comparison of the efficacy, side effects and patient convenience between vaginal and rectal administration of Cyclogest(®) when used for luteal phase support in ICSI treatment. Arch Gynecol Obstet 2012; 286:1049-54. [PMID: 22714063 DOI: 10.1007/s00404-012-2410-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2012] [Accepted: 05/31/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE This study compares the efficacy, side effects and patient convenience of vaginal and rectal routes of administration of progesterone suppositories (Cyclogest) when used for luteal phase support during in vitro fertilization cycles, through the use of antagonist protocols. METHODS 147 patients who underwent intra-cytoplasmic sperm injection cycle were randomized on the day of the embryo transfer (ET) by a computer-generated randomization program to receive 400 mg of Cyclogest either vaginally or rectally twice daily for up to 8 weeks. A pregnancy test was conducted 2 weeks after embryo transfer. If the pregnancy test was negative, the application was discontinued. On day 14th after embryo transfer, patient's acceptability and side effects were assessed using a questionnaire which was given to the patients on the day of ET prior to performing the pregnancy test. The clinical pregnancy rate at the 8th week of gestation and the level of luteal progesterone were evaluated. RESULTS There were no substantial differences in the demographics or other characteristics between the two groups. There were no significant differences in serum P concentration 6 days after ET, the clinical pregnancy and abortion rates. The difficulty of administration route, the discomforts experienced following administration, and the proportion leaking out on the 14th day were similar between the two groups. Significantly more patients administering the medication per vagina had perineal irritation (21.3 vs. 2.2 %). The prevalence of tenesmus (35.1 vs. 21.1 %) and rectal itching (26.7 vs. 2.8 %) were significantly more in rectal route. CONCLUSIONS This study demonstrates that the efficacy of Cyclogest is similar when administered via both the vaginal and rectal routes. Although their side effects differ, the ease of administration for patients and their preference are similar.
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Affiliation(s)
- Malek-Mansour Aghsa
- Department of Obstetrics and Gynecology, Valie-Asr Reproductive Health Research Center, Valie-Asr Hospital (TUMS), Keshavarz Blvd, Tehran, Iran.
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26
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The effect of adenomyosis on in vitro fertilisation and intra-cytoplasmic sperm injection treatment outcome. Eur J Obstet Gynecol Reprod Biol 2011; 158:229-34. [DOI: 10.1016/j.ejogrb.2011.04.030] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Revised: 03/11/2011] [Accepted: 04/30/2011] [Indexed: 11/20/2022]
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Var T, Tonguc EA, Doğanay M, Gulerman C, Gungor T, Mollamahmutoglu L. A comparison of the effects of three different luteal phase support protocols on in vitro fertilization outcomes: a randomized clinical trial. Fertil Steril 2011; 95:985-9. [DOI: 10.1016/j.fertnstert.2010.06.057] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2010] [Revised: 06/02/2010] [Accepted: 06/17/2010] [Indexed: 10/19/2022]
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28
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Montville CP, Khabbaz M, Aubuchon M, Williams DB, Thomas MA. Luteal support with intravaginal progesterone increases clinical pregnancy rates in women with polycystic ovary syndrome using letrozole for ovulation induction. Fertil Steril 2010; 94:678-83. [DOI: 10.1016/j.fertnstert.2009.03.088] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2008] [Revised: 03/12/2009] [Accepted: 03/25/2009] [Indexed: 10/20/2022]
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Patterns of luteal phase bleeding in in vitro fertilization cycles supplemented with Crinone vaginal gel and with intramuscular progesterone--impact of luteal estrogen: prospective, randomized study and post hoc analysis. Fertil Steril 2010; 95:617-20. [PMID: 20537624 DOI: 10.1016/j.fertnstert.2010.04.039] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Revised: 04/12/2010] [Accepted: 04/16/2010] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To compare patterns of luteal phase bleeding (LPB) in IVF cycles supplemented with Crinone and with intramuscular progesterone (IMP) and to evaluate the impact of luteal estrogen supplementation on LPB. DESIGN Prospective, randomized trial and post hoc analysis. SETTING University-affiliated IVF unit. PATIENT(S) Women under age 40 with day 3 FSH <15 mIU/mL were randomized to receive either Crinone or IMP for luteal phase support. Luteal estrogen was prescribed according to clinical protocols. Three hundred sixty-five patients were queried about LPB after completion of their IVF cycles. INTERVENTION(S) Luteal phase supplementation with Crinone or IMP and with estrogen. MAIN OUTCOME MEASURE(S) Incidence of LPB in IVF cycles supplemented with Crinone and IMP and impact of luteal estrogen on the occurrence of LPB. RESULT(S) There was no difference in the overall incidence of LPB between patients treated with Crinone and those treated with IMP (33.2% vs. 25.7%). LPB occurred with equal frequency among pregnant patients in both arms (Crinone 21.9% vs. IMP 18.6%). Only nonpregnant women had a higher incidence of LPB when treated with Crinone compared with treatment with IMP (56.5% vs.38.1%). Estrogen supplementation decreased the occurrence of LPB among all participants but did not impact pregnancy rates. CONCLUSION(S) Only nonpregnant women had a higher incidence of bleeding in the luteal phase when supplemented with Crinone compared with treatment with IMP. IMP delays menses in nonpregnant cycles without affecting pregnancy rates. Luteal estrogen decreases LPB without impacting cycle outcomes.
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Yanushpolsky E, Hurwitz S, Greenberg L, Racowsky C, Hornstein M. Crinone vaginal gel is equally effective and better tolerated than intramuscular progesterone for luteal phase support in in vitro fertilization-embryo transfer cycles: a prospective randomized study. Fertil Steril 2010; 94:2596-9. [PMID: 20347079 DOI: 10.1016/j.fertnstert.2010.02.033] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Revised: 02/02/2010] [Accepted: 02/15/2010] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To compare the efficacy of Crinone vaginal gel and intramuscular progesterone (IMP) for luteal phase support in in vitro fertilization-embryo transfer (IVF-ET) with respect to pregnancy rates and outcomes, and to assess patient satisfaction with both products. DESIGN Prospective randomized trial. SETTING University-affiliated IVF unit. PATIENT(S) Women under age 40 years with day-3 follicle-stimulating hormone levels <15 mIU/mL undergoing their first, second, or third IVF cycles on gonadotropin releasing-hormone (GnRH) down-regulation protocols. INTERVENTION(S) Luteal phase supplementation with either Crinone vaginal gel or IMP; phone survey regarding patient satisfaction with Crinone vaginal gel and IMP. MAIN OUTCOME MEASURE(S) Pregnancy rates, ongoing/delivered, failed pregnancy rates, and product satisfaction scores for patients supplemented with Crinone vaginal gel and with IMP. RESULT(S) Four hundred sixty-eight patients were randomized, and 407 completed the study. The patients were randomized on the day of oocyte retrieval to receive either Crinone vaginal gel or IMP for luteal phase support. Pregnancy, ongoing/delivered, and failed pregnancy rates were similar between the Crinone and IMP treatment arms (OR [95% CI]: 1.2 [0.8, 1.8], 1.1 [0.8, 1.7], 1.0 [0.6, 1.7], respectively). On a scale of 1 to 5, patient satisfaction scores were statistically significantly higher with Crinone vaginal gel than with IMP (4.4 ± 0.9 vs. 2.8 ± 1.2). CONCLUSION(S) Crinone vaginal gel and IMP are equally effective for luteal phase support in IVF, but Crinone is better tolerated by patients.
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Affiliation(s)
- Elena Yanushpolsky
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115-6114, USA.
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Effects of estradiol supplementation during the luteal phase of in vitro fertilization cycles: a meta-analysis. Fertil Steril 2010; 93:428-36. [DOI: 10.1016/j.fertnstert.2009.02.033] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2008] [Revised: 01/29/2009] [Accepted: 02/11/2009] [Indexed: 11/18/2022]
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Devoto L, Kohen P, Muñoz A, Strauss JF. Human corpus luteum physiology and the luteal-phase dysfunction associated with ovarian stimulation. Reprod Biomed Online 2009; 18 Suppl 2:19-24. [PMID: 19406027 DOI: 10.1016/s1472-6483(10)60444-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The human corpus luteum is a temporary endocrine gland that develops after ovulation from the ruptured follicle during the luteal phase. It is an important contributor of steroid hormones, particularly progesterone, and is critical for the maintenance of early pregnancy. Luteal-phase dysfunction can result in premature regression of the gland, with a subsequent shift to an infertile cycle. Understanding the mechanism of steroidogenesis during corpus luteum growth and regression is crucial for evaluating the normal physiology and pathophysiology of reproductive cycles. The rate-limiting step in corpus luteum steroidogenesis is the transport of cholesterol to the site of steroid production. Steroidogenic acute regulatory protein is a key player in this process and is positively correlated with progesterone concentrations throughout the early and mid-luteal phase. Changes in the endocrine environment brought on by the gonadotrophins used for ovarian stimulation are thought to underlie the corpus luteum dysfunction associated with IVF cycles. While ovarian hyperstimulation syndrome is associated with human chorionic gonadotrophin (HCG), studies suggest that exogenous progesterone provides necessary luteal support in patients undergoing IVF. The current trend towards simple stimulation protocols and the use of single-embryo transfers provide further opportunity to revisit HCG administration as luteal support.
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Affiliation(s)
- Luigi Devoto
- Universidad de Chile, Hospital Clinico San Borja-Arriaran, Santiago, Chile.
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Drug delivery for in vitro fertilization: rationale, current strategies and challenges. Adv Drug Deliv Rev 2009; 61:871-82. [PMID: 19426774 DOI: 10.1016/j.addr.2009.04.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2008] [Accepted: 04/28/2009] [Indexed: 11/23/2022]
Abstract
In vitro fertilization has experienced phenomenal progress in the last thirty years and awaits the additional refinement and enhancement of medication delivery systems. Opportunity exists for the novel delivery of gonadotropins, progesterone and other adjuvants. This review highlights the rationale for various medications, present delivery methods and introduces the status of novel ideas and possibilities.
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Abstract
PURPOSE OF REVIEW Luteal phase support (LPS) is an integral part of the IVF cycles treated by gonadotropin-releasing hormone analogues. There is a worldwide controversy concerning the type of hormones used for LPS, its dose, duration, when to start and when to stop. This review will cover original as well as recent data on this topic. RECENT FINDINGS There is a consensus in the literature among IVF centers that LPS is necessary for IVF cycles. Human chorionic gonadotropin is less commonly used than progesterone for LPS because of ovarian hyperstimulation syndrome risk. Several studies suggested that intramuscular progesterone is superior to vaginal progesterone for LPS; however, the majority of centers use vaginal progesterone to avoid side effects of intramuscular injection. There is no difference in pregnancy rate whether LPS is started on day of human chorionic gonadotropin, oocyte retrieval or embryo transfer. There is a strong evidence that LPS should be stopped either on the day of pregnancy test or the first ultrasound (6-7 weeks pregnancy). There is no evidence that addition of estrogen will improve pregnancy rate. SUMMARY Progesterone is the preferred option for LPS. It should start within 2 days from triggering ovulation and should end on day of beta human chorionic gonadotropin or the day of the first ultrasound (6-7 weeks pregnancy).
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Zarutskie PW, Phillips JA. A meta-analysis of the route of administration of luteal phase support in assisted reproductive technology: vaginal versus intramuscular progesterone. Fertil Steril 2009; 92:163-9. [DOI: 10.1016/j.fertnstert.2009.02.018] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2008] [Revised: 02/02/2009] [Accepted: 02/09/2009] [Indexed: 11/26/2022]
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Degrees of Uncertainty—“Statistically Insignificant”. Fertil Steril 2008. [DOI: 10.1016/j.fertnstert.2008.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Claman P. Degrees of uncertainty--"statistically insignificant". Fertil Steril 2008; 90:1331; author reply 1331. [PMID: 18793767 DOI: 10.1016/j.fertnstert.2008.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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