Evaluation Of Various Progesterone Therapy Routes For Luteal Phase Support In IVF: A Systematic Review And Meta-Analysis

Background: The progesterone secreted from the ovary until the seventh week of pregnancy is required to maintain pregnancy. In fertility-assisted cycles, administration of GnRH agonists, can cause Corpus luteum failure and progesterone secreted from the ovary will not be sufficient to protect pregnancy. The best way to prevent this situation is support progesterone administration. Objective: this study aimed to rank the best route of progesterone administration in luteal phase support. Methods: Randomized controlled trials (RCTs) of progesterone for the luteal phase support were identified from online databases of Scopus, Google Scholar, Pubmed. Treatment efficacy was defined as ongoing pregnancy.  Data were extracted and analyzed using odds ratios (ORs). A Bayesian network meta-analysis was performed using the Markov chain Monte Carlo method in WinBUGS and NetMetaXL. Results: Total ۱۱۷۶ participants were studied in ۱۶ trials of ۶ separate progesterone routes including vaginal progesterone gel, progesterone sub q, Dydrogesterone, Cap ۲۰۰ mg TID, Cap ۲۰۰ mg BID, and progesterone IM. Comparison test shows better likelihood of SUCRA followed by vaginal progesterone gel (۷۷.۸%), progesterone sub q (۵۵.۴۹%), Dydrogesterone (۵۳.۹۷%), Cap ۲۰۰ mg TID (۵۰.۶۷%), Cap ۲۰۰ mg BID (۴۸.۹۹%) and finally progesterone IM (۱۳.۰۶%). Conclusion: This study ranked as the best route of progesterone therapy for luteal phase support, through the reviewed studies.

Keywords:

Network meta-analysis , Progesterone , Luteal Phase Support , IVF.