Luteal phase bleeding (LPB) in in vitro fertilization (IVF) cycles supplemented with crinone 8% intravaginal gel (CR) or intramuscular progesterone (IMP)

Abstract

OBJECTIVE: To identify incidence of LPB in IVF cycles supplemented with either CR or IMP and to correlate it with pregnancy outcomes.DESIGN: Planned Interim Analysis of a prospective randomized controlled study.MATERIALS AND METHODS: Women under age 40 with day 3 FSH values <15 mIU/ml undergoing their first, second or third IVF cycle with GnRH agonist downregulation protocol were stratified by age (<35 and 35-39) and randomized to receive either CR or IMP 48 or 24 hours after oocyte retrieval respectively. Patients were phone surveyed at cycle completion regarding incidence of LPB. Pregnancy rates per embryo transfer, miscarriage rates (SAB) and incidence of LPB relative to pregnancy outcome were recorded and analyzed. Two-sided Wald p-values, adjusted for age, were calculated using logistic regression.Table 1Pregnancies, SABs and BleedingOUTCOMELPB N=70 (%)NO LPB N=116 (%)PPregnant (N=119)31/70 (44)88/116 (76)<0.0001SAB (N=31)12/31 (39)19/88 (22)0.07 Open table in a new tab Table 2LPB and Pregnancy Outcomes with CR and IMPOUTCOMECR N=94 (%)IMP N=92 (%)PLPB41/94 (44)29/92 (32)0.08Pregnant61/94 (65)58/92 (63)0.78Pregnant among LPB18/41 (44)13/29 (45)0.96Pregnant among Non-LPB43/53 (81)45/63 (71)0.23SAB17/61 (28)14/58 (24)0.65SAB among LPB9/18 (50)3/13 (23)0.13SAB among Non-LPB8/43 (19)11/45 (24)0.50LPB among Pregnant18/61 (30)13/58 (22)0.38LPB among Non-Pregnant23/33 (70)16/34 (47)0.06LPB among SAB9/17 (53)3/14 (21)0.07LPB among Ongoing Pregnancy9/44 (20)10/44 (23)0.80 Open table in a new tab CONCLUSIONS: 1. LPB is a poor prognostic sign for ongoing pregnancy in IVF; the ongoing pregnancy rate among patients with LPB is not different between CR and IMP. 2. Pregnancy and SAB rates were similar between CR and IMP. 3. The increased LPB with CR observed in this trial occurred in unsuccessful cycles (non-pregnant and SAB). 4. IMP delays bleeding in unsuccessful cycles (non-pregnant and SAB). OBJECTIVE: To identify incidence of LPB in IVF cycles supplemented with either CR or IMP and to correlate it with pregnancy outcomes. DESIGN: Planned Interim Analysis of a prospective randomized controlled study. MATERIALS AND METHODS: Women under age 40 with day 3 FSH values <15 mIU/ml undergoing their first, second or third IVF cycle with GnRH agonist downregulation protocol were stratified by age (<35 and 35-39) and randomized to receive either CR or IMP 48 or 24 hours after oocyte retrieval respectively. Patients were phone surveyed at cycle completion regarding incidence of LPB. Pregnancy rates per embryo transfer, miscarriage rates (SAB) and incidence of LPB relative to pregnancy outcome were recorded and analyzed. Two-sided Wald p-values, adjusted for age, were calculated using logistic regression. CONCLUSIONS: 1. LPB is a poor prognostic sign for ongoing pregnancy in IVF; the ongoing pregnancy rate among patients with LPB is not different between CR and IMP. 2. Pregnancy and SAB rates were similar between CR and IMP. 3. The increased LPB with CR observed in this trial occurred in unsuccessful cycles (non-pregnant and SAB). 4. IMP delays bleeding in unsuccessful cycles (non-pregnant and SAB).