Combined progesterone (IM + V) versus vaginal progesterone for luteal support in cleavage-stage embryo transfer cycles of good prognosis patients

Abstract

Many reports led to the consensus on the use of progesterone (P) for luteal-phase support. Vaginal P application is the method of choice due to its simplicity and high patient convenience but is hampered by application difficulties and personal or cultural aversions. Inappropriate vaginal P use may alter successful implantation, leading physicians to consider alternate P application routes. A worldwide survey revealed that intramuscular plus vaginal P (combined P) is the method used in nearly one-third of in vitro fertilization (IVF) cycles, particularly in Asia and North America; unfortunately, the outcomes of this approach have not been clearly elucidated. In the current analysis, we evaluated any additional benefit of short course parenteral P in addition to vaginal P capsules during a specific period in terms of implantation, pregnancy rates, miscarriages and ectopic pregnancies in cleavage stage embryo transfer (ET) cycles of good-prognosis patients. Despite significantly higher implantation rates in the combined arm, clinical and ongoing pregnancies were comparable in both groups, whereas a trend toward increased pregnancy rates was observed with combined support. The available data are too limited to draw conclusions.

Risk of ovarian cancer in women treated with ovarian stimulating drugs for infertility

“…(2) tamoxifen, a selective oestrogen receptor modulator (SERM); (3) human menopausal gonadotrophin (HMG), which contains follicle-stimulating hormone (FSH) and luteinising hormone; (4) human chorionic gonadotrophin (HCG); (5) gonadotrophin-releasing hormone agonist (GnRH-AG); (6) gonadotrophin-releasing hormone antagonist (GnRH-A); (7) purified FSH; (8) growth hormone; (9) insulin-like growth factor (IGF); (10) progesterone; and (11) letrozole, which is a thirdgeneration aromatase inhibitor (Demir 2016;Du y 2010;Pabuccu 2016). These hormones are used either alone or in combination depending on the cause of infertility and the protocol used.…”

“…During assisted reproduction, levels of progesterone, HCG, or both are low; therefore the natural process may be insu icient to ensure good production of progesterone. This problem is overcome by the use of progesterone, HCG, or GnRH agonists (Demir 2016;Pabuccu 2016; Van der Linden 2011).…”

Efficacy of dual progesterone administration (intramuscular and vaginal) for luteal support in fresh day 3 or day 4 embryo transfer cycles

“…Intramuscular P generally results in higher serum P levels than vagi-nal P [3][4][5]. In fresh IVF-ET cycles, the serum P level during the mid-luteal phase has been reported to be 94.3 ± 8.8 ng/mL when intramuscular (P 100 mg) was administered and 57.7 ± 7.4 ng/mL when a vaginal 8% progesterone gel was used (p< 0.01) [10].…”

“…Administration of P, which is now the main method of luteal support, can be done by intramuscular, subcutaneous, vaginal, and oral routes. The intramuscular route generally results in a higher serum P level than the vaginal route, but serum P levels may not reflect actual P levels in the endometrial tissue [3][4][5]. Intramuscular P administration can frequently cause pain and, in rare cases, abscess formation.…”

“…The combination of intramuscular and vaginal P is used by some clinicians, but little is known about its efficacy [4]. In a study by Pabuccu et al [4], women who received dual luteal support (intramuscular P [50 mg]+vaginal P [200 mg] three times) had a significantly higher implantation rate than those who received vaginal P only, but the clinical pregnancy rate and ongoing pregnancy rate were similar [4]. No study has yet compared fresh ET cycle outcomes between patients who receive intramuscular P and vaginal P and those who receive intramuscular P alone.…”