The optimal route of progesterone administration for luteal phase support in a frozen embryo transfer: a systematic review

Abdulla Almohammadi; Ainharan Raveendran; Mairead Black; Abha Maheshwari

doi:10.1007/s00404-022-06674-2

The optimal route of progesterone administration for luteal phase support in a frozen embryo transfer: a systematic review

Abdulla Almohammadi^* (Corresponding Author), Ainharan Raveendran, Mairead Black, Abha Maheshwari

^*Corresponding author for this work

Research output: Contribution to journal › Review article › peer-review

3 Citations (Scopus)

4 Downloads (Pure)

Abstract

OBJECTIVE: To investigate the optimal route of progesterone administration for luteal phase support in a frozen embryo transfer.

DESIGN: Systematic review.

PATIENTS: Women undergoing frozen embryo transfer (FET).

INTERVENTIONS: We conducted an extensive database search of Medline (PubMed), Embase, Web of Science, and Cochrane Trials Register using relevant keywords and their combinations to find randomized controlled trials (RCTs) comparing the routes (i.e., oral, vaginal, intramuscular) of progesterone administration for luteal phase support (LPS) in artificial FET.

MAIN OUTCOME MEASURES: Clinical pregnancy, live birth, miscarriage.

RESULTS: Four RCTs with 3245 participants undergoing artificial endometrial preparation (EP) cycles during FET were found to be eligible. Four trials compared vaginal progesterone with intramuscular progesterone and two trials compared vaginal progesterone with oral progesterone. One study favored of vaginal versus oral progesterone for clinical pregnancy rates (RR 0.45, 95% CI 0.22-0.92) and other study favored intramuscular versus vaginal progesterone for clinical pregnancy rates (RR 1.46, 95% CI 1.21-1.76) and live birth rates (RR 1.62, 95% CI 1.28-2.05). Tabulation of overall evidence strength assessment showed low-quality evidence on the basis that for each outcome-comparison pair, there were deficiencies in either directness of outcome measurement or study quality.

CONCLUSION: There was little consensus and evidence was heterogeneous on the optimal route of administration of progesterone for LPS during FET in artificial EP cycles. This warrants more trials, indirect comparisons, and network meta-analyses.

PROPERO NO: CRD42021251017.

Original language	English
Pages (from-to)	341-350
Number of pages	10
Journal	Archives of Gynecology and Obstetrics
Volume	308
Issue number	2
Early online date	9 Aug 2022
DOIs	https://doi.org/10.1007/s00404-022-06674-2
Publication status	Published - 1 Aug 2023

Bibliographical note

Acknowledgements: University of Aberdeen library for conducting the database search.

Funding: Open Access funding provided by the Qatar National Library.

Data Availability Statement

Not applicable.

Keywords

luteal phase support
miscarriage
live birth
progesterone
frozen embryo transfer

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Cite this

The optimal route of progesterone administration for luteal phase support in a frozen embryo transfer: a systematic review. / Almohammadi, Abdulla (Corresponding Author); Raveendran, Ainharan; Black, Mairead et al.
In: Archives of Gynecology and Obstetrics, Vol. 308, No. 2, 01.08.2023, p. 341-350.

Research output: Contribution to journal › Review article › peer-review

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abstract = "OBJECTIVE: To investigate the optimal route of progesterone administration for luteal phase support in a frozen embryo transfer.DESIGN: Systematic review.PATIENTS: Women undergoing frozen embryo transfer (FET).INTERVENTIONS: We conducted an extensive database search of Medline (PubMed), Embase, Web of Science, and Cochrane Trials Register using relevant keywords and their combinations to find randomized controlled trials (RCTs) comparing the routes (i.e., oral, vaginal, intramuscular) of progesterone administration for luteal phase support (LPS) in artificial FET.MAIN OUTCOME MEASURES: Clinical pregnancy, live birth, miscarriage.RESULTS: Four RCTs with 3245 participants undergoing artificial endometrial preparation (EP) cycles during FET were found to be eligible. Four trials compared vaginal progesterone with intramuscular progesterone and two trials compared vaginal progesterone with oral progesterone. One study favored of vaginal versus oral progesterone for clinical pregnancy rates (RR 0.45, 95% CI 0.22-0.92) and other study favored intramuscular versus vaginal progesterone for clinical pregnancy rates (RR 1.46, 95% CI 1.21-1.76) and live birth rates (RR 1.62, 95% CI 1.28-2.05). Tabulation of overall evidence strength assessment showed low-quality evidence on the basis that for each outcome-comparison pair, there were deficiencies in either directness of outcome measurement or study quality.CONCLUSION: There was little consensus and evidence was heterogeneous on the optimal route of administration of progesterone for LPS during FET in artificial EP cycles. This warrants more trials, indirect comparisons, and network meta-analyses.PROPERO NO: CRD42021251017.",

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author = "Abdulla Almohammadi and Ainharan Raveendran and Mairead Black and Abha Maheshwari",

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AU - Almohammadi, Abdulla

AU - Raveendran, Ainharan

AU - Black, Mairead

AU - Maheshwari, Abha

N1 - Acknowledgements: University of Aberdeen library for conducting the database search. Funding: Open Access funding provided by the Qatar National Library.

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N2 - OBJECTIVE: To investigate the optimal route of progesterone administration for luteal phase support in a frozen embryo transfer.DESIGN: Systematic review.PATIENTS: Women undergoing frozen embryo transfer (FET).INTERVENTIONS: We conducted an extensive database search of Medline (PubMed), Embase, Web of Science, and Cochrane Trials Register using relevant keywords and their combinations to find randomized controlled trials (RCTs) comparing the routes (i.e., oral, vaginal, intramuscular) of progesterone administration for luteal phase support (LPS) in artificial FET.MAIN OUTCOME MEASURES: Clinical pregnancy, live birth, miscarriage.RESULTS: Four RCTs with 3245 participants undergoing artificial endometrial preparation (EP) cycles during FET were found to be eligible. Four trials compared vaginal progesterone with intramuscular progesterone and two trials compared vaginal progesterone with oral progesterone. One study favored of vaginal versus oral progesterone for clinical pregnancy rates (RR 0.45, 95% CI 0.22-0.92) and other study favored intramuscular versus vaginal progesterone for clinical pregnancy rates (RR 1.46, 95% CI 1.21-1.76) and live birth rates (RR 1.62, 95% CI 1.28-2.05). Tabulation of overall evidence strength assessment showed low-quality evidence on the basis that for each outcome-comparison pair, there were deficiencies in either directness of outcome measurement or study quality.CONCLUSION: There was little consensus and evidence was heterogeneous on the optimal route of administration of progesterone for LPS during FET in artificial EP cycles. This warrants more trials, indirect comparisons, and network meta-analyses.PROPERO NO: CRD42021251017.

AB - OBJECTIVE: To investigate the optimal route of progesterone administration for luteal phase support in a frozen embryo transfer.DESIGN: Systematic review.PATIENTS: Women undergoing frozen embryo transfer (FET).INTERVENTIONS: We conducted an extensive database search of Medline (PubMed), Embase, Web of Science, and Cochrane Trials Register using relevant keywords and their combinations to find randomized controlled trials (RCTs) comparing the routes (i.e., oral, vaginal, intramuscular) of progesterone administration for luteal phase support (LPS) in artificial FET.MAIN OUTCOME MEASURES: Clinical pregnancy, live birth, miscarriage.RESULTS: Four RCTs with 3245 participants undergoing artificial endometrial preparation (EP) cycles during FET were found to be eligible. Four trials compared vaginal progesterone with intramuscular progesterone and two trials compared vaginal progesterone with oral progesterone. One study favored of vaginal versus oral progesterone for clinical pregnancy rates (RR 0.45, 95% CI 0.22-0.92) and other study favored intramuscular versus vaginal progesterone for clinical pregnancy rates (RR 1.46, 95% CI 1.21-1.76) and live birth rates (RR 1.62, 95% CI 1.28-2.05). Tabulation of overall evidence strength assessment showed low-quality evidence on the basis that for each outcome-comparison pair, there were deficiencies in either directness of outcome measurement or study quality.CONCLUSION: There was little consensus and evidence was heterogeneous on the optimal route of administration of progesterone for LPS during FET in artificial EP cycles. This warrants more trials, indirect comparisons, and network meta-analyses.PROPERO NO: CRD42021251017.

KW - luteal phase support

KW - miscarriage

KW - live birth

KW - progesterone

KW - frozen embryo transfer

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DO - 10.1007/s00404-022-06674-2

M3 - Review article

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SN - 0932-0067

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JO - Archives of Gynecology and Obstetrics

JF - Archives of Gynecology and Obstetrics

IS - 2

ER -

The optimal route of progesterone administration for luteal phase support in a frozen embryo transfer: a systematic review

Abstract

Bibliographical note

Data Availability Statement

Keywords

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