TY - JOUR
T1 - The efficacy and safety of luteal phase support with progesterone following ovarian stimulation and intrauterine insemination
T2 - A systematic review and meta-analysis
AU - Casarramona, G.
AU - Lalmahomed, T.
AU - Lemmen, C. H.C.
AU - Eijkemans, M. J.C.
AU - Broekmans, F. J.M.
AU - Cantineau, A. E.P.
AU - Drechsel, K. C.E.
N1 - Publisher Copyright:
Copyright © 2022 Casarramona, Lalmahomed, Lemmen, Eijkemans, Broekmans, Cantineau and Drechsel.
PY - 2022/9/2
Y1 - 2022/9/2
N2 - The aim of this systematic review and meta-analysis was to update the current evidence for the efficacy and safety of progesterone luteal phase support (LPS) following ovarian stimulation and intrauterine insemination treatment (OS-IUI) for unexplained or mild male infertility. Four additional studies were identified compared to the previous review in 2017. Twelve RCTs (2631 patients, 3262 cycles) met full inclusion criteria. Results from quantitative synthesis suggest that progesterone LPS after OS-IUI leads to higher live birth (RR 1.38, 95%CI [1.09, 1.74]; 7 RCTs, n=1748) and clinical pregnancy rates (RR 1.38, 95% CI [1.21, 1.59]; 11 RCTs, n=2163) than no LPS or placebo. This effect is specifically present in protocols using gonadotropins for OS-IUI (RR 1.41, 95%CI [1.17, 1.71]; 7 RCTs, n=1114), and unclear in protocols involving clomiphene citrate (RR 1.01, 95% CI [0.05, 18.94]; 2 RCTs, n=138). We found no effect of progesterone LPS on multiple pregnancy or miscarriage rates. No correlation between drug-dosage or duration of treatment and effect size was seen. Though our results suggest both benefit and safety of progesterone LPS in OS-IUI, evidence is of low to moderate quality and additional well-powered trials are still mandatory to confirm our findings and justify implementation in daily practice. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=292325, identifier CRD42021292325.
AB - The aim of this systematic review and meta-analysis was to update the current evidence for the efficacy and safety of progesterone luteal phase support (LPS) following ovarian stimulation and intrauterine insemination treatment (OS-IUI) for unexplained or mild male infertility. Four additional studies were identified compared to the previous review in 2017. Twelve RCTs (2631 patients, 3262 cycles) met full inclusion criteria. Results from quantitative synthesis suggest that progesterone LPS after OS-IUI leads to higher live birth (RR 1.38, 95%CI [1.09, 1.74]; 7 RCTs, n=1748) and clinical pregnancy rates (RR 1.38, 95% CI [1.21, 1.59]; 11 RCTs, n=2163) than no LPS or placebo. This effect is specifically present in protocols using gonadotropins for OS-IUI (RR 1.41, 95%CI [1.17, 1.71]; 7 RCTs, n=1114), and unclear in protocols involving clomiphene citrate (RR 1.01, 95% CI [0.05, 18.94]; 2 RCTs, n=138). We found no effect of progesterone LPS on multiple pregnancy or miscarriage rates. No correlation between drug-dosage or duration of treatment and effect size was seen. Though our results suggest both benefit and safety of progesterone LPS in OS-IUI, evidence is of low to moderate quality and additional well-powered trials are still mandatory to confirm our findings and justify implementation in daily practice. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=292325, identifier CRD42021292325.
KW - infertility
KW - intrauterine insemination
KW - luteal (phase) support
KW - meta-analysis
KW - ovarian stimulation
KW - progesterone
UR - http://www.scopus.com/inward/record.url?scp=85138197918&partnerID=8YFLogxK
U2 - 10.3389/fendo.2022.960393
DO - 10.3389/fendo.2022.960393
M3 - Review article
AN - SCOPUS:85138197918
SN - 1664-2392
VL - 13
SP - 1
EP - 16
JO - Frontiers in Endocrinology
JF - Frontiers in Endocrinology
M1 - 960393
ER -