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.

  • Micah Hill

    We appreciate the opportunity to discuss our meta-analysis from this month and welcome any other questions or comments!

  • Lauren Johnson

    Congratulations
    to Micah and colleagues on a very well-done meta-analysis! This article was
    timely for our division as we recently reviewed the literature on the efficacy
    of progesterone supplementation in ovulation induction cycles. While the
    meta-analysis indicates that P4 luteal support improves LBR and clinical
    pregnancy rate in gonadotrophin IUI cycles, the optimal duration of P4
    treatment is not known. Given the limitations of the data, how do you generally
    counsel patients about duration of P4 treatment and route of administration?

    • Micah Hill

      Thank you for the comments Lauren. As you say, the data is very limited on duration of the P support. I personally give them 8 weeks of support, similar to what we do with our IVF patients. But I suspect that time could be significantly shortened in IUI patients where the suppression is much less than fully down-regulated IVF patients.

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