Die vaginale Anwendung von natürlichem Progesteron als Lutealphasenunterstützung nach IVF und Embryotransfer

Abstract

The beneficial effect of luteal phase support after embryo transfer in IVF treatment (IVF-ET) has unequivocally been accepted. Various substances (human chorionic gonadotropin (hCG), progesterone (P), estradiol [E2]) and regimens of administration are employed. The present systematic review aims at determining the efficacy of administration of vaginal Pas capsules, suppositories or vaginal cream versus other forms of luteal phase support (including Crinone® 8% vaginal gel) after ovarian hyperstimulation and IVF-ET. The available literature was reviewed and data on clinical pregnancy rates per embryo transfer was retrieved from randomised controlled trials. 24 studies with a total of 5334 randomized patients in 33 group comparisons were included in this review. In these studies, various doses of vaginal P as capsules/suppositories/vaginal cream in various administration regimens were evaluated. The following subgroups were identified: vaginal P vs. 1) intra-muscular P (odds ratio [OR] 0.99 [95% confidence interval {CI} 0.58-1.72]); 2) hCG (1.13 [0.84-1.52]); 3) vaginal P + hCG (1.02 [0.76-1.36]); 4) Crinone® 8% (0.96 [0.76-1.22]); 5) vaginal P + oral E2 (1.03 [0.68-1.56]); and 6) orally administered P or gestagen (1.11 [0.69-1.76]). Results of individual studies were homogenous in subgroup comparisons except for vaginal P vs. intra-muscular P. Current data from the literature indicate no significant difference between vaginal Pas capsules/suppositories/cream as compared to a wide range of other forms of luteal phase support after IVF.