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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

Meta-analysis (A), sensitivity analysis (B), and funnel plot (C) for the odds ratio of miscarriage. CI = confidence interval.
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Figure 6: Meta-analysis (A), sensitivity analysis (B), and funnel plot (C) for the odds ratio of miscarriage. CI = confidence interval.

Mentions: A total of 8 of the 11 studies reported miscarriage rate data (Table 5).17,19,20,21,23–26 There was no significant difference between P + E and P treatments with respect to miscarriage rate (pooled OR 0.633, 95% CI 0.342–1.172; P = 0.146) (Figure 6A). A random-effects model was used, as there was heterogeneity among the studies (Q = 12.191, P = 0.094; I2 = 42.58). With exception of the study by Gorkemli et al,25 all other pooled ORs remained <1.0 and were nonsignificant when each study was removed in turn, indicating no obvious influence on the overall pooled estimate from any of those remaining 7 studies (Figure 6B). The study by Gorkemli et al (point estimate 0.523, P = 0.031) might influence the pooled estimate but was not removed since its point estimate is in the same direction as the overall pooled OR. The Egger test showed an estimated intercept of −2.15, with a 1-tailed P = 0.182, indicating no significant asymmetry or bias (Figure 6C).


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)

Meta-analysis (A), sensitivity analysis (B), and funnel plot (C) for the odds ratio of miscarriage. CI = confidence interval.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 6: Meta-analysis (A), sensitivity analysis (B), and funnel plot (C) for the odds ratio of miscarriage. CI = confidence interval.
Mentions: A total of 8 of the 11 studies reported miscarriage rate data (Table 5).17,19,20,21,23–26 There was no significant difference between P + E and P treatments with respect to miscarriage rate (pooled OR 0.633, 95% CI 0.342–1.172; P = 0.146) (Figure 6A). A random-effects model was used, as there was heterogeneity among the studies (Q = 12.191, P = 0.094; I2 = 42.58). With exception of the study by Gorkemli et al,25 all other pooled ORs remained <1.0 and were nonsignificant when each study was removed in turn, indicating no obvious influence on the overall pooled estimate from any of those remaining 7 studies (Figure 6B). The study by Gorkemli et al (point estimate 0.523, P = 0.031) might influence the pooled estimate but was not removed since its point estimate is in the same direction as the overall pooled OR. The Egger test showed an estimated intercept of −2.15, with a 1-tailed P = 0.182, indicating no significant asymmetry or bias (Figure 6C).

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