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Estrogen supplementation to progesterone as luteal phase support in patients undergoing in vitro fertilization: systematic review and meta-analysis.

Zhang XM, Lv F, Wang P, Huang XM, Liu KF, Pan Y, Dong NJ, Ji YR, She H, Hu R - Medicine (Baltimore) (2015)

Bottom Line: Meta-analyses have found conflicting results with respect to the use of progesterone or progesterone plus estrogen as luteal phase support for in vitro fertilization (IVF) protocols involving gonadotropins and/or gonadotropin-releasing hormone analogs.Results of statistical analyses indicated that progesterone plus estrogen treatment was more likely to result in clinical pregnancy than progesterone alone (pooled odds ratio 1.617, 95% confidence interval 1.059-2.471; P = 0.026).No significant difference between the 2 treatment regimens was found for the other outcome measures.

View Article: PubMed Central - PubMed

Affiliation: From the Reproductive Medicine Center (X-MZ, FL, PW, X-MH, K-FL, YP, N-JD, Y-RJ, HS), Department of Obstetrics and Gynecology, Northern Jiangsu People's Hospital, Yangzhou University, Yangzhou, Jiangsu; and Reproductive Medicine Center (RH), Key Laboratory of Fertility Preservation and Maintenance of Ministry of Education, Ningxia Medical University, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China.

ABSTRACT
Meta-analyses have found conflicting results with respect to the use of progesterone or progesterone plus estrogen as luteal phase support for in vitro fertilization (IVF) protocols involving gonadotropins and/or gonadotropin-releasing hormone analogs. The aim of the present study was to perform an updated meta-analysis on the efficacy of progesterone versus progesterone plus estrogen as luteal phase support. We searched the MEDLINE, Cochrane Library, and Google Scholar databases (up to March 18, 2014). The search terms were (estrogen OR estradiol OR oestradiol) AND (progesterone) AND (IVF OR in vitro fertilization) AND (randomized OR prospective). We did not limit the form of estrogen and included subjects who contributed more than 1 cycle to a study. The primary outcome was clinical pregnancy rate. Secondary outcomes were ongoing pregnancy rate, fertilization rate, implantation rate, and miscarriage rate. A total of 11 articles were included in the present analysis, with variable numbers of studies assessing each outcome measure. Results of statistical analyses indicated that progesterone plus estrogen treatment was more likely to result in clinical pregnancy than progesterone alone (pooled odds ratio 1.617, 95% confidence interval 1.059-2.471; P = 0.026). No significant difference between the 2 treatment regimens was found for the other outcome measures. Progesterone plus estrogen for luteal phase support is associated with a higher clinical pregnancy rate than progesterone alone in women undergoing IVF, but other outcomes such as ongoing pregnancy rate, fertilization rate, implantation rate, and miscarriage rate are the same for both treatments.

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Related in: MedlinePlus

Flow diagram of study selection. GnRH = gonadotropin-releasing hormone.
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Figure 1: Flow diagram of study selection. GnRH = gonadotropin-releasing hormone.

Mentions: The initial search identified 315 articles (Figure 1). We identified abstracts with full-text articles, and performed manual search of relevant reference lists but did not identify additional articles. A total of 296 articles were excluded, and 19 were subjected to full-text review. Eight more articles were excluded for the following reasons: not performed in women stimulated with gonadotropins and/or GnRH analogs (n = 3), having no outcome of interest (n = 2), no progesterone-alone group (n = 1), not a randomized controlled trial (n = 1), and having no retrievable article (n = 1) (Supplemental ). Thus, 11 articles17–27 were included in the meta-analysis.


Estrogen supplementation to progesterone as luteal phase support in patients undergoing in vitro fertilization: systematic review and meta-analysis.

Zhang XM, Lv F, Wang P, Huang XM, Liu KF, Pan Y, Dong NJ, Ji YR, She H, Hu R - Medicine (Baltimore) (2015)

Flow diagram of study selection. GnRH = gonadotropin-releasing hormone.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4554142&req=5

Figure 1: Flow diagram of study selection. GnRH = gonadotropin-releasing hormone.
Mentions: The initial search identified 315 articles (Figure 1). We identified abstracts with full-text articles, and performed manual search of relevant reference lists but did not identify additional articles. A total of 296 articles were excluded, and 19 were subjected to full-text review. Eight more articles were excluded for the following reasons: not performed in women stimulated with gonadotropins and/or GnRH analogs (n = 3), having no outcome of interest (n = 2), no progesterone-alone group (n = 1), not a randomized controlled trial (n = 1), and having no retrievable article (n = 1) (Supplemental ). Thus, 11 articles17–27 were included in the meta-analysis.

Bottom Line: Meta-analyses have found conflicting results with respect to the use of progesterone or progesterone plus estrogen as luteal phase support for in vitro fertilization (IVF) protocols involving gonadotropins and/or gonadotropin-releasing hormone analogs.Results of statistical analyses indicated that progesterone plus estrogen treatment was more likely to result in clinical pregnancy than progesterone alone (pooled odds ratio 1.617, 95% confidence interval 1.059-2.471; P = 0.026).No significant difference between the 2 treatment regimens was found for the other outcome measures.

View Article: PubMed Central - PubMed

Affiliation: From the Reproductive Medicine Center (X-MZ, FL, PW, X-MH, K-FL, YP, N-JD, Y-RJ, HS), Department of Obstetrics and Gynecology, Northern Jiangsu People's Hospital, Yangzhou University, Yangzhou, Jiangsu; and Reproductive Medicine Center (RH), Key Laboratory of Fertility Preservation and Maintenance of Ministry of Education, Ningxia Medical University, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China.

ABSTRACT
Meta-analyses have found conflicting results with respect to the use of progesterone or progesterone plus estrogen as luteal phase support for in vitro fertilization (IVF) protocols involving gonadotropins and/or gonadotropin-releasing hormone analogs. The aim of the present study was to perform an updated meta-analysis on the efficacy of progesterone versus progesterone plus estrogen as luteal phase support. We searched the MEDLINE, Cochrane Library, and Google Scholar databases (up to March 18, 2014). The search terms were (estrogen OR estradiol OR oestradiol) AND (progesterone) AND (IVF OR in vitro fertilization) AND (randomized OR prospective). We did not limit the form of estrogen and included subjects who contributed more than 1 cycle to a study. The primary outcome was clinical pregnancy rate. Secondary outcomes were ongoing pregnancy rate, fertilization rate, implantation rate, and miscarriage rate. A total of 11 articles were included in the present analysis, with variable numbers of studies assessing each outcome measure. Results of statistical analyses indicated that progesterone plus estrogen treatment was more likely to result in clinical pregnancy than progesterone alone (pooled odds ratio 1.617, 95% confidence interval 1.059-2.471; P = 0.026). No significant difference between the 2 treatment regimens was found for the other outcome measures. Progesterone plus estrogen for luteal phase support is associated with a higher clinical pregnancy rate than progesterone alone in women undergoing IVF, but other outcomes such as ongoing pregnancy rate, fertilization rate, implantation rate, and miscarriage rate are the same for both treatments.

Show MeSH
Related in: MedlinePlus