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Oral versus intramuscular progesterone for in vitro fertilization: a prospective randomized study
F L Licciardi1, A Kwiatkowski, N L Noyes
1Department of Obstetrics and Gynecology, New York University School of Medicine, New York 10016, USA.
Objective:
To evaluate the efficacy of oral micronized progesterone compared with IM progesterone in oil for luteal support in patients undergoing IVF who are treated with a GnRH agonist.
Design:
Randomized prospective clinical trial.
Setting:
University-based IVF center.
Patient(S):
Women <40 years of age who were undergoing IVF with luteal GnRH pituitary down-regulation.
Intervention(S):
Patients were randomized to receive either oral micronized progesterone (200 mg three times daily) or IM progesterone (50 mg daily).
Main Outcome Measure(S):
Progesterone levels at standardized days 21 and 28, and pregnancy and embryo implantation rates.
Result(S):
Day 21 progesterone levels were 77.6+/-13.2 ng/mL in the IM group and 81.5+/-16.2 ng/mL in the oral group. Day 28 progesterone levels were 76.3+/-15.0 ng/mL in the IM group and 53.6+/-10.1 ng/mL in the oral group. The clinical pregnancy rates were 57.9% and 45.8% for the IM and oral groups, respectively. The implantation rate per embryo was significantly higher in the IM group (40.9%) than in the oral group (18.1%).
Conclusion(S):
When used according to our protocols, oral progesterone and IM progesterone result in comparable levels of circulating progesterone. However, oral progesterone results in a reduced implantation rate per embryo.