Vaginal versus intramuscular progesterone for luteal phase support in assisted reproductive technology: A systematic review with meta-analysis

Abstract

Objective: To compare the intramuscular and vaginal routes of progesterone administration for luteal phase support with assisted reproductive technologies (ART).Design: Systematic Review with Meta-Analysis.Materials and Methods: Computerized databases, references in published studies, textbook chapters, and proceedings from the American Society of Reproductive Medicine, European Society of Human Reproduction and Embryology, Society for Gynecologic Investigation, and Pacific Coast Reproductive Society in all languages were used to identify randomized trials evaluating progesterone for luteal phase support in ART. Randomized trials were identified that compared intramuscular versus vaginal progesterone for luteal phase support in in-vitro fertilization (IVF) cycles, egg donor cycles and programmed thaw cycles that evaluated at least one of the following: clinical pregnancy rates, implantation rates, early spontaneous abortion rates, ongoing pregnancy rates or live birth rates. The primary outcomes assessed were clinical and ongoing pregnancy rates. Each trial was assessed for inclusion and exclusion criteria, methodologic quality, sampling protocols, definition of outcomes, and statistical analyses. For each study with binary outcomes, odds ratio (OR) with 95% confidence intervals (CI) were calculated for selected outcomes. Estimates of OR for dichotomous outcomes were calculated utilizing fixed and random-effects models. Homogeneity was tested across the studies.Results: Ten studies met inclusion criteria for this review. When comparing clinical pregnancy rates between women allocated to the IM versus the vaginal progesterone support group, no statistically significant difference between the groups was noted (OR 1.19; 95% CI 0.86,1.64). Furthermore, no statistically significant difference in ongoing pregnancy rates between the IM and vaginal groups was observed (OR 0.93; 95% CI 0.39,2.18). Additionally, no differences were noted for implantation rates, early spontaneous abortion rates, and live birth rates between these two routes of progesterone administration.Conclusion: The vaginal route of progesterone administration for luteal phase support in ART is as efficacious as the IM route and is associated with fewer side effects and greater patient adherence and satisfaction. Objective: To compare the intramuscular and vaginal routes of progesterone administration for luteal phase support with assisted reproductive technologies (ART). Design: Systematic Review with Meta-Analysis. Materials and Methods: Computerized databases, references in published studies, textbook chapters, and proceedings from the American Society of Reproductive Medicine, European Society of Human Reproduction and Embryology, Society for Gynecologic Investigation, and Pacific Coast Reproductive Society in all languages were used to identify randomized trials evaluating progesterone for luteal phase support in ART. Randomized trials were identified that compared intramuscular versus vaginal progesterone for luteal phase support in in-vitro fertilization (IVF) cycles, egg donor cycles and programmed thaw cycles that evaluated at least one of the following: clinical pregnancy rates, implantation rates, early spontaneous abortion rates, ongoing pregnancy rates or live birth rates. The primary outcomes assessed were clinical and ongoing pregnancy rates. Each trial was assessed for inclusion and exclusion criteria, methodologic quality, sampling protocols, definition of outcomes, and statistical analyses. For each study with binary outcomes, odds ratio (OR) with 95% confidence intervals (CI) were calculated for selected outcomes. Estimates of OR for dichotomous outcomes were calculated utilizing fixed and random-effects models. Homogeneity was tested across the studies. Results: Ten studies met inclusion criteria for this review. When comparing clinical pregnancy rates between women allocated to the IM versus the vaginal progesterone support group, no statistically significant difference between the groups was noted (OR 1.19; 95% CI 0.86,1.64). Furthermore, no statistically significant difference in ongoing pregnancy rates between the IM and vaginal groups was observed (OR 0.93; 95% CI 0.39,2.18). Additionally, no differences were noted for implantation rates, early spontaneous abortion rates, and live birth rates between these two routes of progesterone administration. Conclusion: The vaginal route of progesterone administration for luteal phase support in ART is as efficacious as the IM route and is associated with fewer side effects and greater patient adherence and satisfaction.