Intramuscular progesterone versus 8% Crinone vaginal gel for luteal phase support for day 3 cryopreserved embryo transfer

Capsule:
Luteal support with 8% Crinone was associated with lower odds of clinical pregnancy and live birth compared with intramuscular progesterone in a multivariable analysis of day 3 cryopreserved embryo transfer cycles.

Authors:
Daniel J. Kaser, M.D., Elizabeth S. Ginsburg, M.D., Stacey A. Missmer, Sc.D., Katharine F. Correia, M.A., Catherine Racowsky, Ph.D.

Volume 98, Issue 6, Pages 1464-1469, December 2012

Abstract:

Objective:
To compare outcomes following intramuscular 84 progesterone (IMP) or 8% Crinone vaginal gel for luteal support for day 3 cryopreserved embryo transfer (CET).

Design:
Retrospective cohort study with multivariable analysis.

Setting:
Academic medical center.

Patients:
All autologous and donor egg IVF and ICSI patients who had a day 3 CET between January 1, 2008 and April 30, 2011 with luteal support using IMP 25-50 mg/d or Crinone 8% twice daily, initiated 3 days before the CET.

Interventions:
None.

Main outcome measures:
Implantation rate, clinical pregnancy and live birth rates per CET.

Results:
IMP (n=440) and Crinone (n=298) recipients were similar for all demographic characteristics and cycle parameters assessed. While implantation rates did not differ significantly for the two progesterone groups (Crinone vs. IMP: 19.6% vs. 30.4%), women supplemented with Crinone had significantly lower rates of clinical pregnancy (36.9% vs. 51.1%) and live birth (24.4% vs. 39.1%) compared with those on IMP.

Conclusions:
We observed that Day 3 CET cycles with Crinone 8% luteal support have a 44% and 49% lower odds of clinical pregnancy and live birth, respectively, compared to those with IMP support. Further studies are required to identify the optimal timing and dose of Crinone 8% vaginal gel for use in CET cycles.

  • The study addresses a very important topic- progesterone support in frozen embryo transfer cycles. The obtained results are very interesting and would suggest using the IM route, even though the vaginal gel may be more patient-friendly. It would be interesting to know what the serum progesterone levels were in both groups- future studies / RCTs may further address this point.

  • I have read this article with interest. There are few studies with comparisons on Crinone
    vaginal gel and intramuscular progesterone. However, four meta-analysis
    comparing vaginal vs intramuscular (IM) route have been published from 2002
    until now. The biggest and the most recent reports 13 studies showing similar
    clinical pregnancy rates between both routes (Van der linde, 2012). This
    confirms the findings of a previous meta-analysis with 9 studies (Zaruskie,2009).
    In contrast, two meta-analysis found lower clinical pregnancy rates when progesterone was administrated by vaginal route compared with IM (Pritts EA , 2002 ; Daya S, 2004).That means it is really difficult to establish if one route is better than the other. Given that the implantation rates did not differ significantly between IM vs Crinone, the clinical pregnancy and live birth rates are different, therefore the benefit of IM progesterone could be helping to maintain the early pregnancy. I would be interested to know how the implantation rate was calculated as a different method is usually used.

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