Luteal phase support may improve pregnancy outcomes during intrauterine insemination cycles

To determine the impact of luteal phase support with vaginal progesterone on pregnancy outcomes in infertile couples undergoing intrauterine insemination when recombinant follicle-stimulating hormone was used for ovulation induction.

This prospective randomized study was undertaken at the Infertility Unit, Armed Forces Hospital Southern Region, Kingdom of Saudi Arabia, and included 71 patients with either primary or secondary infertility who met the inclusion criteria. All 71 patients underwent intrauterine insemination. Thirty-seven were randomized to start with a supported cycle and 34 started with an unsupported cycle. In supported cycles, patients received vaginal progesterone once daily from the day after insemination for 14 days. No progesterone was given during unsupported cycles. For the second cycle, crossover occurred such that women who initially had a supported cycle underwent an unsupported cycle, and vice versa. The cycle types were alternated until the end of the study. The main outcome measures were clinical pregnancy rates and livebirth rates per cycle and per patient.

In total, 132 supported cycles and 126 unsupported cycles were performed successfully. The clinical pregnancy rate per patient was higher for supported than unsupported cycles (54.92% vs. 35.21%, respectively; p=0.016), but the per-cycle difference was not significant (29.54% vs. 19.84%, respectively; p=0.07). Twenty-five pregnancies in supported cycles and seven pregnancies in unsupported cycles resulted in live births. When these rates were compared per cycle and per patient, significant differences were detected between the cycle types (18.9% and 35.2% vs. 5.5% and 9.8%; p=0.001 and <0.001, respectively).

Luteal phase support with vaginal progesterone improved the success of intrauterine insemination cycles when recombinant follicle-stimulating hormone was used for ovulation induction.

Luteal phase support may improve pregnancy outcomes during intrauterine insemination cycles, but large multicentre, placebo-controlled, double-blind trials are needed.