Intramuscular progesterone optimizes live birth from programmed frozen embryo transfer: a randomized clinical trial

Devine, Kate; Richter, Kevin S.; Jahandideh, Samad; Widra, E.A.; McKeeby, Jeffrey

doi:10.1016/j.fertnstert.2021.04.013

Cited by 37 publications

(25 citation statements)

References 34 publications

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“…After removal of duplicates and irrelevant titles/abstracts, and addition of 3 citations captured in update searches, 36 studies were shortlisted for review of full-text articles. Four RCTs with 3245 participants undergoing artificial EP cycles during FET were found to be eligible [26][27][28][29] (Fig. 1).…”

Section: Included Studiesmentioning

confidence: 99%

The optimal route of progesterone administration for luteal phase support in a frozen embryo transfer: a systematic review

Almohammadi

Raveendran

Black

et al. 2022

Arch Gynecol Obstet

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Objective To investigate the optimal route of progesterone administration for luteal phase support in a frozen embryo transfer. Design Systematic review. Patients Women undergoing frozen embryo transfer (FET). Interventions We conducted an extensive database search of Medline (PubMed), Embase, Web of Science, and Cochrane Trials Register using relevant keywords and their combinations to find randomized controlled trials (RCTs) comparing the routes (i.e., oral, vaginal, intramuscular) of progesterone administration for luteal phase support (LPS) in artificial FET. Main outcome measures Clinical pregnancy, live birth, miscarriage. Results Four RCTs with 3245 participants undergoing artificial endometrial preparation (EP) cycles during FET were found to be eligible. Four trials compared vaginal progesterone with intramuscular progesterone and two trials compared vaginal progesterone with oral progesterone. One study favored of vaginal versus oral progesterone for clinical pregnancy rates (RR 0.45, 95% CI 0.22–0.92) and other study favored intramuscular versus vaginal progesterone for clinical pregnancy rates (RR 1.46, 95% CI 1.21–1.76) and live birth rates (RR 1.62, 95% CI 1.28–2.05). Tabulation of overall evidence strength assessment showed low-quality evidence on the basis that for each outcome-comparison pair, there were deficiencies in either directness of outcome measurement or study quality. Conclusion There was little consensus and evidence was heterogeneous on the optimal route of administration of progesterone for LPS during FET in artificial EP cycles. This warrants more trials, indirect comparisons, and network meta-analyses. PROPERO No CRD42021251017.

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Section: Included Studiesmentioning

confidence: 99%

The optimal route of progesterone administration for luteal phase support in a frozen embryo transfer: a systematic review

Almohammadi

Raveendran

Black

et al. 2022

Arch Gynecol Obstet

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“…Very recently, the results of the final analysis were reported. The LBR was significantly lower in the vaginal P-only arm (27%) when compared with im P (44%) or vaginal P supplemented with im P every third day (46%); however, no significant difference was noted between im P or vaginal P supplemented with im P every third day (35). One of the limitations of that study is heterogeneity as regards timing of FET in the three arms; vitrified blastocysts were warmed and transferred on the 5 th day of P in the vaginal P administration (with or without im P), whereas in subjects assigned to the im P only group, vitrified blastocysts were warmed and transferred on the 6 th day of P administration.…”

Section: Progesterone Administrationmentioning

confidence: 80%

Preparation of the Endometrium for Frozen Embryo Transfer: A Systematic Review

et al. 2021

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Despite the worldwide increase in frozen embryo transfer, the search for the best protocol to prime endometrium continues. Well-designed trials comparing various frozen embryo transfer protocols in terms of live birth rates, maternal, obstetric and neonatal outcome are urgently required. Currently, low-quality evidence indicates that, natural cycle, either true natural cycle or modified natural cycle, is superior to hormone replacement treatment protocol. Regarding warmed blastocyst transfer and frozen embryo transfer timing, the evidence suggests the 6th day of progesterone start, LH surge+6 day and hCG+7 day in hormone replacement treatment, true natural cycle and modified natural cycle protocols, respectively. Time corrections, due to inter-personal differences in the window of implantation or day of vitrification (day 5 or 6), should be explored further. Recently available evidence clearly indicates that, in hormone replacement treatment and natural cycles, there might be marked inter-personal variation in serum progesterone levels with an impact on reproductive outcomes, despite the use of the same dose and route of progesterone administration. The place of progesterone rescue protocols in patients with low serum progesterone levels one day prior to warmed blastocyst transfer in hormone replacement treatment and natural cycles is likely to be intensively explored in near future.

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“…In one of these studies, days of progesterone pre transfer based on type of progesterone differed which may have affected the results. However, when vaginal combined with every third day intra muscular P4 was compared to vaginal P4 only for the same duration, pre treatment outcomes were better when injectable P4 was included [6]. The second study used equivalent duration of progesterone supplementation with the intra muscular arms have higher live birth rates than did the vaginal P4 alone group.…”

Section: Introductionmentioning

confidence: 99%

“…The vaginal route is effective in fresh stimulated IVF cycles. In frozen IVF cycles it is debated if vaginal supplementation is as effective as intra muscular injections of P4 [6].…”

Section: Introductionmentioning

confidence: 99%

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Vaginal Progesterone Gel Versus İntramuscular Progesterone For Luteal Support In Suboptimal Responders According To The Poseidon Criteria (Group 1b), Undergoing Antagonist IVF/ICSI-Cycles.

Ulubaşoğlu¹,

Bakay

Yavuzcan

et al. 2022

Preprint

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Purpose:The aim of this study is to investigate the efficacy of intravaginal micronized progesterone gel 8% (VP8) versus intramuscular progesterone in oil (IM P4) for luteal phase support after IVF/ICSI -embryo transfer cycles in POSEIDON suboptimal responder patients.Methods:We evaluated the data of 189 suboptimal responders who underwent antagonist IVF/ICSI treatments. This retrospective study was conducted on patients who were treated by a university IVF center between January 2010 and December 2015. We evaluated the data of 189 suboptimal responders who underwent antagonist IVF/ICSI treatments.The cycles were categorized into two groups based on the type of luteal support: P4 vaginal gel and P4 IM. Clinical pregnancy, ongoing pregnancy, live birth and spontaneous abortion rates were analyzed. Results: Patient and treatment characteristics were similar in both groups. However, In terms of infertile duration, significant differences were observed between groups (P<0.05). There were no significant differences in stimulation characteristics including; total gonadotropin doses, peak serum estradiol levels on the day of triggering, number of oocytes collected and number of fertilized oocyte. Multivariate logistic regression modeling failed to find the type of progesterone used as a predictor of live birth (OR 0.802, 95% CI 661-1.202, p=0.580). Conclusion:We believed in POSEIDOIN group IB patients similar pregnancy outcomes can be obtained by administering 180 mg P4 gel vaginally when compared to IM P4.

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Intramuscular progesterone optimizes live birth from programmed frozen embryo transfer: a randomized clinical trial

Cited by 37 publications

References 34 publications

The optimal route of progesterone administration for luteal phase support in a frozen embryo transfer: a systematic review

The optimal route of progesterone administration for luteal phase support in a frozen embryo transfer: a systematic review

Preparation of the Endometrium for Frozen Embryo Transfer: A Systematic Review

Vaginal Progesterone Gel Versus İntramuscular Progesterone For Luteal Support In Suboptimal Responders According To The Poseidon Criteria (Group 1b), Undergoing Antagonist IVF/ICSI-Cycles.

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