Die vaginale anwendung von natürlichem progesteron als lutealphasenunterstützung nach IVF und embryotransfer

The beneficial effect of luteal phase support after embryo transfer in IVF treatment (IVF-ET) has unequivocally been accepted. Various substances (human chorionic gonadotropin (hCG), progesterone (P), estradiol [E2]) and regimens of administration are employed. The present systematic review aims at determining the efficacy of administration of vaginal P as capsules, suppositories or vaginal cream versus other forms of luteal phase support (including Crinone ^® 8% vaginal gel) after ovarian hyperstimulation and IVF-ET. The available literature was reviewed and data on clinical pregnancy rates per embryo transfer was retrieved from randomised controlled trials. 24 studies with a total of 5334 randomized patients in 33 group comparisons were included in this review. In these studies, various doses of vaginal P as capsules/suppositories/vaginal cream in various administration regimens were evaluated. The following subgroups were identified: vaginal P vs. 1) intra-muscular P (odds ratio [OR] 0.99 [95% confidence interval {CI} 0.58-1.72]); 2) hCG (1.13 [0.84-1.52]); 3) vaginal P + hCG (1.02 [0.76-1.36]); 4) Crinone^® 8% (0.96 [0.76-1.22]); 5) vaginal P + oral E2 (1.03 [0.68-1.56]); and 6) orally administered P or gestagen (1.11 [0.69-1.76]). Results of individual studies were homogenous in subgroup comparisons except for vaginal P vs. intra-muscular P. Current data from the literature indicate no significant difference between vaginal Pas capsules/suppositories/cream as compared to a wide range of other forms of luteal phase support after IVF.