Comparison of Luteal Support Protocols in Frozen IVF/ICSI Cycles: A Network Meta-Analysis

Area of Science:

• Reproductive Endocrinology
• Assisted Reproductive Technology
• Clinical Trial Analysis

Background:

• Luteal support is critical for successful frozen embryo transfers (FET).
• Current protocols for luteal support show significant variability, leading to inconsistent reproductive outcomes.

Purpose of the Study:

• To identify the most effective luteal support strategy (LPS) for frozen embryo transfer (FET) cycles.
• To evaluate key factors influencing the efficacy of luteal support in FET.

Main Methods:

• A comprehensive literature search of 12 databases and 2 registers was conducted.
• Bayesian network meta-analysis (NMA) of randomized controlled trials (RCTs) and observational studies involving 4688 participants.
• Primary outcomes included clinical pregnancy, live birth, and miscarriage rates.

Main Results:

• Fourteen studies comparing 12 interventions were included.
• Vaginal progesterone combined with a single or double dose of subcutaneous GnRH agonist significantly improved clinical pregnancy rates (RR 1.86 [95% CrI 1.18, 2.93]).
• The risk of bias was moderate, with low network inconsistency across outcomes.

Conclusions:

• Adding 0.1 mg subcutaneous GnRH agonist (single or double dose) to a vaginal progesterone regimen up to 12 weeks improves clinical pregnancy in FET cycles.
• This enhanced luteal support strategy offers a promising approach to optimize FET success rates.