A prospective randomized study comparing intramuscular with intravaginal natural progesterone in programmed thaw...

Area of Science:

• Reproductive Endocrinology
• In Vitro Fertilization (IVF)

Background:

• Programmed thaw cycles in IVF typically involve endometrial preparation using oestradiol and progesterone.
• Injectable progesterone-in-oil has been effective but poses patient compliance challenges due to daily injections.

Purpose of the Study:

• To compare the efficacy and clinical outcomes of vaginal progesterone versus intramuscular (IM) progesterone-in-oil in programmed thaw cycles.
• To evaluate if a vaginal progesterone preparation can effectively replace injectable progesterone while maintaining similar pregnancy rates.

Main Methods:

• A prospective randomized study involving 170 thawing cycles with IM progesterone and 184 with vaginal progesterone.
• Endometrial preparation involved oral oestradiol followed by either IM progesterone-in-oil or vaginal progesterone.
• Clinical pregnancy rates were defined as the percentage of thawing cycles with a gestational sac at 4 weeks post-embryo transfer.

Main Results:

• Clinical pregnancy rates were similar between the injectable (15.9%) and vaginal (16.8%) progesterone groups.
• While IM progesterone yielded higher serum progesterone concentrations (more than double), implantation and abortion rates were comparable between groups.
• Vaginal progesterone application was associated with comparable uterine progesterone concentrations.

Conclusions:

• Oral oestradiol combined with vaginal progesterone is an effective, simple, and cost-effective strategy for programmed thaw cycles.
• Vaginal progesterone provides a viable and patient-preferred alternative to injectable progesterone, achieving similar reproductive outcomes.
• This approach minimizes blood tests and utilizes inexpensive medications, enhancing patient experience in assisted reproductive technologies.