Does the Time of Starting Progesterone Luteal Support Affect Embryo Transfer in Long Agonist Protocol Downregulated ICSI Cycles? A Randomized Controlled Trial

Ghanem, M.; Bedairy, M.H.; Shaaban, A.; Albahlol, Ibrahim A

doi:10.1007/s43032-020-00309-0

Cited by 1 publication

(3 citation statements)

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“…In our study, we evaluated the different application routes of luteal phase support, which provided more evidence for the use of delayed LPS. Ghanem ME and colleagues found that the initiation of LPS on the oocyte retrieval day was associated with a poorer cycle outcome on day five (but not on day three) ET, when compared with the initiation of LPS on the ET day [ 19 ]. Williams et al reported of a lower pregnancy rate in patients who started progesterone on day six after oocyte retrieval, compared with day three after oocyte retrieval; however, this article performed ET 3 days after oocyte retrieval [ 50 ].…”

Section: Discussionmentioning

confidence: 99%

“…Williams et al reported of a lower pregnancy rate in patients who started progesterone on day six after oocyte retrieval, compared with day three after oocyte retrieval; however, this article performed ET 3 days after oocyte retrieval [ 50 ]. In our review, only these two studies performed LPS until 96 h after oocyte retrieval, and we could not evaluate the influence of further delaying LPS until later timepoints [ 19 , 50 ]. Future studies are needed to address the gaps in the evidence.…”

Section: Discussionmentioning

confidence: 99%

“…With regard to the timing of progesterone initiation, a systematic review recommended the initiation of LPS between the evening of oocyte retrieval and 3 days after oocyte retrieval; however, the article included limited studies that exhibited with obvious heterogeneity [ 36 ]. A recent RCT found a significantly lower ongoing pregnancy rate when starting LPS on the oocyte retrieval day, compared with day five after embryo transfer (ET) [ 19 ]. When considering the potential benefits of delaying vaginal progesterone and the shortage of meta-analyses, it would be essential to compare different progesterone initiations during the luteal phase.…”

Section: Introductionmentioning

confidence: 99%

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Luteal phase support for in vitro fertilization/intracytoplasmic sperm injection fresh cycles: a systematic review and network meta-analysis

Lin

Wang

et al. 2021

Reprod Biol Endocrinol

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Background Various luteal phase supports (LPSs) have been proven to increase the pregnancy rate in fresh cycles of in vitro fertilization or intracytoplasmic sperm injection; however, there is still significant debate regarding the optimal use of LPS. Methods A systematic review with the use of a network meta-analysis was performed via electronic searching of Ovid MEDLINE, the Cochrane Library, Embase, Web of Science, ClinicalTrials.gov and Google Scholar (up to January 2021) to compare the effectiveness and safety of various LPSs, as well as to evaluate the effects of different initiations of LPSs on pregnancy outcomes. The primary outcomes included live birth and ongoing pregnancy, with the results presented as odds ratios (ORs) with 95% confidence intervals (CIs). Results Eighty-nine randomized controlled trials with 29,625 women comparing 14 interventions or placebo/no LPS treatments were included in the meta-analyses. No significant differences were found in terms of the pregnancy outcomes when LPS was started within 48 h after oocyte retrieval versus a delayed initiation between 48 h and 96 h after oocyte retrieval. The addition of gonadotropin-releasing hormone (GnRH) agonists to progesterone vaginal pessaries showed a significant benefit in terms of live birth (OR 1.39, 95% CI 1.08 to 1.78). Only human chorionic gonadotropin (HCG) was found to be more efficacious than the placebo/no LPS treatment in terms of live birth (OR 15.43, 95% CI 2.03 to 117.12, low evidence). Any active LPSs (except for rectal or subcutaneous progesterone) was significantly more efficacious than the placebo/no LPS treatment in terms of ongoing pregnancy, with ORs ranging between 1.77 (95% CI 1.08 to 2.90) for the vaginal progesterone pessary and 2.14 (1.23 to 3.70) for the intramuscular progesterone treatment. Among the comparisons of efficacy and tolerability between the active treatments, the differences were small and very uncertain. Conclusion Delays in progesterone supplementation until 96 h after oocyte retrieval does not affect pregnancy outcomes. The safety of GnRH agonists during the luteal phase needs to be evaluated in future studies before the applications of these agonists in clinical practice. With comparable efficacy and acceptability, there may be several viable clinical options for LPS.

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Section: Discussionmentioning

confidence: 99%