Vaginal versus intramuscular progesterone for luteal phase support in assisted reproductive techniques: a systematic review and meta-analysis of randomized controlled trials

Abstract

We aimed to compare the efficacy of vaginal progesterone versus intramuscular progesterone (IMP) for luteal phase support in assisted reproductive techniques (ART). A comprehensive electronic search of four electronic databases (PubMed, Cochrane Library, Scopus, and ISI Web of Science) was performed from inception till August 2019 for randomized controlled trials (RCTs). We included studies performed different ART with the use of vaginal progesterone versus IMP for luteal phase support. Our primary outcome was clinical pregnancy rate. Our secondary outcomes were ongoing pregnancy, miscarriage, live birth rates, and satisfaction in both groups. 15 RCTs met our inclusion criteria with a total of 5656 patients. Our analysis indicated no significant differences between vaginal progesterone and IMP regarding clinical and ongoing pregnancies (RR = 0.90, 95% CI [0.80, 1.00], p = .06), (RR = 0.90, 95% CI [0.76, 1.06], p = .21), respectively. No significant differences were found between both routes of progesterone in miscarriage (p = .98) and live birth (p = .99). Subgroup analysis between fresh and frozen embryo transfer cycles in above outcomes showed no difference between progesterone routes. Vaginal progesterone was significantly associated with more satisfaction compared to IMP (p < .00001). In conclusion, vaginal progesterone can be used an alternative method for luteal phase support instead of IMP in ART.

摘要

我们的目的是比较经阴道孕酮和肌注孕酮(IMP)在辅助生殖技术(ART)中支持黄体的效果。对4个电子数据库(PubMed、Cochrane Library、Scopus和ISI Web of Science)进行全面的电子搜索, 从最初到2019年8月进行随机对照试验(RCT)。我们纳入了使用阴道孕酮和IMP支持黄体进行不同ART的研究。我们的主要结果是临床妊娠率。我们的次要结果是两组的持续妊娠、流产、活产率和满意度。15个随机对照试验符合我们的纳入标准, 共有5656名患者。我们的分析表明, 阴道孕酮和IMP在临床妊娠和持续妊娠方面没有显著差异(RR＝0.90, 95%CI[0.80, 1.00], p＝.06), (RR＝0.90, 95%CI[0.76, 1.06], p＝.21)。两种途径的黄体酮在流产(p＝.98)和活产(p＝.99)方面没有显著差异。上述结果的新鲜胚胎移植周期和冷冻胚胎移植周期之间的亚组分析显示, 不同的黄体酮途径没有差异。与IMP相比, 阴道孕酮与更多的满意度显著相关(p<.00001)。结论：在ART中, 阴道孕酮可以替代IMP作为黄体期支持的替代方法。

The Chinese abstracts are translated by Prof. Dr. Xiangyan Ruan and her team: Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China.

Keywords:

• Luteal phase support
• assisted reproduction
• vaginal progesterone
• intra-muscular progesterone

Disclosure statement

All authors confirm no financial or personal relationship with a third party whose interests could be positively or negatively influenced by the article’s content.