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

Abstract

Background: The rate of multiple pregnancies in IVF/ICSI ranges from 20 to 30%. The incidence of preterm birth in multiple pregnancies is as high as 60% and is even higher in pregnancies conceived after IVF & ICSI. The effect of progesterone on prevention of preterm birth in twins is controversial. Our group has proven a positive effect in reduction of preterm birth, by starting progesterone from the mid-trimester, in exclusively IVF/ICSI singleton pregnancies but not twins. The purpose of our current study was to explore the effect of earlier administration of natural progesterone, in IVF/ICSI twin pregnancies starting at 11-14 weeks for prevention of preterm birth. Methods: This is a double-blind, placebo controlled, single center, randomized clinical trial. Women with dichorionic twin gestations, having an IVF/ICSI trial were randomized to receive natural rectal progesterone (800 mg daily) vs placebo, starting early from 11 to 14 weeks. They also received oral and vaginal antimicrobial agents as part of our routine treatment for vaginitis and urinary tract infection. They were randomized regardless of cervical length and had no previous history of preterm birth or known Mullerian anomalies. The primary outcome was spontaneous preterm birth rate before 37 weeks. The secondary outcome was; spontaneous preterm birth before 34, 32, 28 weeks and neonatal outcome. Results: A total of 203 women were randomized to both groups, final analysis included 199 women as 4 were lost to follow up. The base line characteristics as well as gestational age at delivery were not significantly different between the study and the placebo group (34.7 ± 3.6 vs 34.5 ± 4.5, P = 0.626). Progesterone administration was not associated with a significant decrease in the spontaneous preterm birth rates before 37 weeks (73.5% vs 68%, P = 0.551), before 34 (20.6% vs 21.6%, P = 0.649), before 32 (8.8% vs 12.4%, P = 0.46) & before 28 (4.9% vs 3.1%, P = 0.555) weeks. Conclusions: Rectal natural progesterone starting from the first trimester in IVF/ICSI twin pregnancies did not reduce spontaneous preterm birth.

Interventions for preventing preterm birth in multiple gestations with short cervix -- a systematic review and network meta-analysis

“…We selected 33 papers for assessment of the full paper (Figure S1). We excluded 13 studies: 5 studies without CL measurement [15][16][17][18][19] , 2 studies with the wrong population 20,21 , 2 studies considered duplicate patient population 22,23 , and 1 study included patients with a previous episode of threatened preterm labor 24 . For three studies, there was concern about trustworthiness of the data 25,26,27 .…”

Using deep learning to predict the outcome of live birth from more than 10,000 embryo data

“…It is worth noting that the live birth rate in this study showed a high level (45.6%). As we all know, age and ovarian reserve are very important factors that determine the clinical pregnancy rate and live birth rate of IVF [ 30 ]. This higher live birth rate may be related to the younger population in this study (average age is 30.4 years) and better ovarian reserve (average number of oocytes retrieved is 12.9).…”

Prevention of Preterm Birth by Cervical Pessary Combined with Vaginal Progesterone: a Systematic Review and Meta-analysis with Trial Sequential Analysis

“…For some pregnancies, it is likely that vaginal progesterone alone was already sufficient in risk mitigation, so any additional or marginal benefit of other interventions would be difficult to discern [ 12 ]. Fourth, progesterone can be natural or synthetic (17alpha-hydroxyprogesterone caproate) and administered orally, intramuscularly, vaginally, or rectally [ 49 ]; some meta-analysis showed that there were differences in the efficacy of different routes or source [ 50 , 51 ]. However, only vaginal natural progesterone was reported to be combined with pessary and included in our study.…”