Progesterone luteal support after ovulation induction and intrauterine insemination a systematic review and meta analysis

Capsule:
Progesterone for luteal support after ovulation induction IUI was associated with increased likelihood of pregnancy and live birth in gonadotropin cycles but not in clomiphene citrate (CC) cycles.

Authors:
Micah J. Hill, D.O., Brian W. Whitcomb, Ph.D., Terrence D. Lewis, M.D., Mae Wu, D.O., Nancy Terry, Alan H. DeCherney, M.D., Eric D. Levens, M.D., Anthony M. Propst, M.D.

Volume 100, Issue 5, Pages 1373-1380.e6, November 2013

Abstract:

Objective:
To evaluate the effect of luteal phase P support after ovulation induction IUI.

Design:
A systematic review and meta-analysis.

Setting:
Not applicable.

Patient(s):
Undergoing ovulation induction IUI.

Intervention(s):
Any form of exogenous P in ovulation induction IUI cycles.

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

Result(s):
Five trials were identified that met inclusion criteria and comprised 1,298 patients undergoing 1,938 cycles. Clinical pregnancy (odds ratio [OR] 1.47, 95% confidence interval [CI] 1.15–1.98) and live birth (OR 2.11, 95% CI 1.21–3.67) were more likely in P-supplemented patients. These findings persisted in analyses evaluating per IUI cycle, per patient, and first cycle only data. In subgroup analysis, patients receiving gonadotropins for ovulation induction had the most increase in clinical pregnancy with P support (OR 1.77, 95% CI 1.20–2.6). Conversely, patients receiving clomiphene citrate (CC) for ovulation induction showed no difference in clinical pregnancy with P support (OR 0.89, 95% CI 0.47–1.67).

Conclusion(s):
Progesterone luteal phase support may be of benefit to patients undergoing ovulation induction with gonadotropins in IUI cycles. Progesterone support did not benefit patients undergoing ovulation induction with CC, suggesting a potential difference in endogenous luteal phase function depending on the method of ovulation induction.

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