Progesterone for Luteal Phase Support in in Vitro Fertilization: Comparison of Vaginal and Rectal Pessaries to Vaginal Capsules: A Randomized Controlled Study

Abstract

BACKGROUNDIn IVF, Luteal phase support is usually performed using vaginal progesterone. A part of patients using this route reports being uncomfortable with this route. We tried to study whether the rectal route could be an effective alternative and associated with less discomfort.PATIENTS AND METHODSA prospective randomized controlled study. All patient were eligible for IVF treatment for infertility. After oocyte pickup, 186 patients were allocated to one the following protocols for luteal phase support: (i) rectal pessaries group: natural progesterone pessaries administered rectally 200 mg three times a day, (ii) vaginal pessaries group: natural progesterone pessaries administered vaginally 200 mg three times a day), and (iii) vaginal capsules group: natural micronized progesterone capsules administered vaginally 200 mg three times a day. On the day of pregnancy test, patients were asked to fill in a questionnaire conducted by an investigator in order to assess the tolerability and side effects of the LPS treatment taken. The primary endpoint was the occurrence of perineal irritation.RESULTSFifty eight patients were assigned to the rectal pessaries group, 68 patients to the vaginal pessaries group, and 60 patients to the vaginal capsules group. All patients adhered to their allocated treatment. Implantation and clinical pregnancy rates per transfer did not differ between the three groups. Perineal irritation, which was our primary endpoint, was the same for all the three groups (respectively 1.7 % versus 5.9 % versus 11.7%). Regarding the other side effects, more patients experienced constipation and flatulence with the rectal route, whereas more patients reported vaginal discharge in the vaginal capsules group.CONCLUSIONRectal administration for luteal phase support is effective and well accepted alternative to vaginal route.

The effect of early administration of rectal progesterone in IVF/ICSI twin pregnancies on the preterm birth rate: A randomized trial

“…We used the rectal route instead of the vaginal route while all previously published studies used the vaginal route [7][8][9][10]12,13]. However, the rectal route has previously been studied and found to be as effective as the vaginal route [29][30][31][32][33]. With reports of high serum progesterone levels with high doses [33].…”

“…With reports of high serum progesterone levels with high doses [33]. .We chose this route because our previous experience also has shown more patient acceptability, comfort, and compliance with the rectal route [29]. It may also minimize any possibility of infection through the twice daily application of vaginal suppositories.…”

A questionnaire-based audit to assess overall experience and convenience among patients using vaginal progesterone tablets (Lutigest^®) for luteal phase support during IVF treatment

“…Vaginal progesterone preparations are known to be associated with vulvovaginal side effects, 24 – 29 with vaginal discharge being the most common and reported in over 80% of women using vaginally administered progesterone. 24 As expected, most patients in the current audit reported experiencing extra vaginal discharge while using progesterone tablets for LPS.…”

“… 2 Although all the different vaginal progesterone formulations contain the same active ingredient, associated side effects, inconvenience, and difficulty of use differ. 24 – 29 Progesterone pessaries (Cyclogest ® ) contain natural progesterone and are commonly used for LPS during IVF procedures. 29 – 31 However, melting of the pessary at body temperature in the vagina can lead to increased vaginal discharge, vaginal buildup, and vaginal irritation.…”

“… 24 – 29 Progesterone pessaries (Cyclogest ® ) contain natural progesterone and are commonly used for LPS during IVF procedures. 29 – 31 However, melting of the pessary at body temperature in the vagina can lead to increased vaginal discharge, vaginal buildup, and vaginal irritation. 32 , 33 Both progesterone gel (Crinone ® ) and progesterone capsules (Utrogestan ® ) contain micronized progesterone.…”