Luteal phase support for natural cycle frozen embryo transfer: a meta-analysis

Abstract

Purpose

We aimed to evaluate the effect of luteal phase support (LPS) on pregnancy outcome in natural cycle frozen embryo transfer (NC-FET).

Method

We searched PubMed, Cochrane Library, Embase for related literature from start to February 2020. Relative risk ratio (RR) and 95% confidence intervals (95% CI) in random-effects, fixed-effects models were calculated using Review Manager 5.3.

Results

Totally 9 studies were included in the meta-analysis. The results showed no significant difference could be found regarding chemical pregnancy rate (RR 1.07, 95% CI 0.93–1.22; I² = 54%) and miscarriage rate (RR 0.92, 95% CI 0.70–1.22; I² = 0%) between the LPS groups and no LPS groups in NC-FET. LPS groups has increased the rate of clinical pregnancy rate (RR 1.23, 95% CI 1.12–1.34; I² = 52%) compared with no LPS groups. Subgroup analysis according to trigger administration also showed a significant difference between the two groups.

Conclusion

LPS might improve the clinical pregnancy rate in NC-FET. HCG trigger for ovulating may result in luteal phase deficiency. LPS subsequently improved clinical pregnancy rate and chemical pregnancy rate for patients undergoing HCG trigger and NC-FET.

Retrospectively registered

This meta-analysis was registered at PROSPERO, PROSPERO ID is CRD42020171758.

自然周期冷冻胚胎移植的黄体期支持：荟萃分析 摘要

目的：我们旨在评估黄体期支持（LPS）对自然周期冷冻胚胎移植（NC-FET）妊娠结局的影响。

方法：我们从 2020 年 2 月开始在 PubMed、Cochrane 图书馆、Embase 中搜索相关文献。使用 Review Manager 5.3 计算随机效应、固定效应模型中的相对风险比 (RR) 和 95% 置信区间 (95% CI) 。

结果：荟萃分析共纳入 9 项研究。结果显示, 自然周期冷冻胚胎移植的LPS组和无LPS组之间的生化妊娠率（RR 1.07, 95% CI 0.93–1.22; I²=54%）和流产率（RR 0.92, 95% CI 0.70–1.22; I²=0%）无显著差异。与无 LPS 组相比, LPS 组增加了临床妊娠率 (RR 1.23, 95% CI 1.12–1.34; I²=52%)。根据是否给药的亚组分析也显示两组之间存在显著差异。

结论：黄体期支持可提高自然周期冷冻胚胎移植临床妊娠率。促排卵的 HCG 扳机可能导致黄体期不足。对NC-FET 的患者进行黄体期支持提高了HCG 扳机后临床妊娠率和化学妊娠率。

回顾性注册：该荟萃分析已在 PROSPERO 注册, PROSPERO ID 为CRD42020171758。

Keywords:

• Luteal phase support
• natural cycle
• frozen embryo transfer
• pregnancy outcome
• meta-analysis

Disclosure statement

No potential conflict of interest was reported by the authors.