Timing luteal support in assisted reproductive technology A systematic review

Capsule:
Initiation of progesterone for luteal support may impact pregnancy rates (PRs). Starting progesterone before oocyte retrieval or 6 days after retrieval likely decreases PRs.

Authors:
Matthew T. Connell, D.O., Jennifer M. Szatkowski, B.S., Nancy Terry, Alan H. DeCherney, M.D., Anthony M. Propst, M.D., Micah J. Hill, D.O.

Volume 103, Issue 4, Pages 939-946

Abstract:

Objective:
To summarize the available published randomized controlled trial data regarding timing of P supplementation during the luteal phase of patients undergoing assisted reproductive technology (ART).

Design:
A systematic review.

Setting:
Not applicable.

Patient(s):
Undergoing IVF.

Intervention(s):
Different starting times of P for luteal support.

Main Outcome Measure(s):
Clinical pregnancy (PR) and live birth rates.

Result(s):
Five randomized controlled trials were identified that met inclusion criteria with a total of 872 patients. A planned meta-analysis was not performed because of a high degree of clinical heterogeneity with regard to the timing, dose, and route of P. Two studies compared P initiated before oocyte retrieval versus the day of oocyte retrieval and PRs were 5%–12% higher when starting P on the day of oocyte retrieval. One study compared starting P on day 6 after retrieval versus day 3, reporting a 16% decrease in pregnancy in the day 6 group. Trials comparing P start times on the day of oocyte retrieval versus 2 or 3 days after retrieval showed no significant differences in pregnancy.

Conclusion(s):
There appears to be a window for P start time between the evening of oocyte retrieval and day 3 after oocyte retrieval. Although some studies have suggested a potential benefit in delaying vaginal P start time to 2 days after oocyte retrieval, this review could not find randomized controlled trials to adequately assess this. Further randomized clinical trials are needed to better define P start time for luteal support after ART.

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