Does multifollicular development and number of intermediate follicles contribute to the effect of luteal phase support with vaginal progesterone gel in intrauterine insemination cycles?

Abstract

Luteal phase deficiency as a result of multifollicular development which produces supraphysiological progesterone and estradiol levels and benefit of luteal phase support have been proven in assisted reproductive technique (ART) treatment. But, there were some controversial results in intrauterine insemination (IUI) cycles whether luteal phase support (LPS) with progesterone have an impact on pregnancy outcome. To assess the efficacy of vaginal progesterone gel in the gonadotropin-induced IUI cycles, this retrospective data analysis compared the luteal phase support and control group in terms of clinical pregnancy (CPR) and live birth rates (LBR). In subgroup analysis, multifollicular and monofollicular growth were analyzed separately. In total, after exclusion criteria, 380 IUI cycles were analyzed, cycles were grouped as LPS(+) and LPS(-) with 190 and 190 cycles, respectively. CPR and LBR were comparable between groups (11.6% vs. 10.5, p = .74 and 8.9% vs. 8.4%, p = .75 respectively). Although multifollicular growth demonstrated higher pregnancy outcomes than monofollicular growth, intermediate follicles (14–16 mm) had a positive impact on pregnancy outcome in monofollicular growth like multifollicular subgroup. We found no difference in CPR and LBR according to the luteal phase vaginal progesterone gel. Nevertheless, multifollicular cycles and also monofollicular growth cycles with two and more intermediate follicles may have benefit LPS in gonadotropin-induced IUI cycles.

摘要

黄体期功能不足是多卵泡发育的结果, 会产生超生理性孕酮和雌二醇水平, 黄体期支持的益处已在辅助生殖技术（ART）治疗中得到证实。但是, 在人工受精（IUI）周期中, 孕酮所起的黄体支持（LPS）是否对妊娠结局有影响存在争议。为了评估阴道黄体酮凝胶在促性腺激素诱导的IUI周期中的有效性, 本回顾性数据分析比较了黄体期支持组和对照组在临床妊娠率（CPR）和活产率（LBR）方面的差异。亚组分析中, 对多卵泡生长和单卵泡生长分别进行分析。总的来说, 去除不符合入组标准者后, 对380个IUI周期进行了分析, 周期被分组为LPS（+）和LPS（-）各190例。各组间CPR和LBR比较（分别为11.6% vs. 10.5, p= .74和8.9% vs. 8.4%, p= .75)。尽管多卵泡生长比单卵泡生长显示出更好的妊娠结局, 中间卵泡（14 - 16mm）对单卵泡样多卵泡亚群妊娠结局有积极影响。我们发现, 阴道黄体酮凝胶对黄体期的CPR和LBR无差异。然而, 在促性腺激素诱导的IUI周期中, 多卵泡周期和含有两个或更多中间卵泡的单卵泡生长周期可能对LPS有益。

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
• vaginal progesterone
• intrauterine insemination
• multifollicular growth
• pregnancy rate

Disclosure statement

No potential conflict of interest was reported by the authors.