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Luteal phase support in assisted reproduction cycles
1Department of Obstetrics & Gynecology, Clinical Epidemiology & Biostatistics, McMaster University, HSC-3N52, 1200 Main Street West, Hamilton, Ontario, Canada, L8N 3Z5.
The Cochrane Database of Systematic Reviews
|July 22, 2004
Summary
Luteal phase support with human chorionic gonadotropin (hCG) or progesterone increases pregnancy rates in assisted reproduction technology (ART) treatments. Progesterone is recommended over hCG due to a lower risk of ovarian hyperstimulation syndrome (OHSS).
Area of Science:
- Reproductive Endocrinology
- Assisted Reproductive Technology
- Clinical Trials
Background:
- Granulosa cell aspiration and GnRH agonist (GnRHa) use in ART can impair luteal phase progesterone production, crucial for embryo implantation.
- Hormonal supplementation with progesterone or hCG may enhance implantation and pregnancy rates in ART cycles.
Purpose of the Study:
- To evaluate the efficacy of luteal phase support in increasing ART pregnancy rates.
- To compare the effectiveness of hCG, progesterone, or combination therapy for luteal phase support.
- To determine the optimal route for progesterone administration.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials (RCTs) and quasi-randomized trials.
- Searched multiple databases including Cochrane, MEDLINE, and EMBASE up to December 2003.
- Extracted data on live birth, pregnancy, miscarriage, OHSS, and multiple pregnancy rates.
Main Results:
- Luteal phase support with hCG significantly increased ongoing pregnancy rates and decreased miscarriage rates when used with GnRHa, but elevated OHSS risk 20-fold.
- Progesterone showed a modest but significant increase in pregnancy rates, with no effect on miscarriage rates.
- No significant differences in pregnancy or miscarriage rates were found between progesterone and hCG, but hCG use was associated with a 2-fold higher OHSS risk.
Conclusions:
- Both hCG and progesterone as luteal phase support improve pregnancy rates in ART.
- Progesterone is a safer option than hCG, especially when GnRHa is used, due to lower OHSS risk.
- The optimal route for progesterone administration remains undetermined.