The Comparison between the Compliance of Different Forms and Routes of Progesterone Administration in the Luteal Phase Support in Intracytoplasmic Sperm Injection Cases

Abstract

During assisted reproductive technology (ART) treatment, the use of gonadotrophin releasing hormone (GnRH) agonists and the aspiration of follicular fluid can lead to a relative progesterone deficit and inappropriate preparation of the endometrium for embryo implantation. Defective production of progesterone may impair implantation and pregnancy rates, given the important role of this hormone in early pregnancy. Supplementation of progesterone in the luteal phases after in vitro fertilization (IVF) cycles significantly improves fertility outcomes compared with no treatment. Nowadays the need for luteal support in IVF treatment has been universally recognized. Progesterone can be administered by oral, intramuscular or vaginal routes. However, the optimal route has not yet been established. Particularly in these cycles, progesterone supplementation is given as IM injection of natural progesterone-in- oil. The IM administration of an oily preparation has not aroused great enthusiasm in most patients and it is often associated with painful injection and rash. Unfortunately, there are few practical alternatives to this route of the administration. In-deed, although progesterone can be also administered orally or vaginally, the former route is inappropriate for inducing the endometrial transformations normally seen in the luteal phase and it is associated with a significantly lower implantation rate per embryo transferred. Although there is increasing evidence that vaginal and intramuscular progesterone are at least equally effective in IVF treatment outcomes, lower clinical pregnancy and delivery rates when using vaginal progesterone rather than intramuscular progesterone-in-oil has been reported in a meta-analysis of randomized trials. However, through the use of vaginal progesterone, painful application of intramuscular injections and their complications, such as local soreness, abscesses, and inflammatory reactions, were avoided. The purpose of this retrospective study was to compare the efficacy of four forms of progesterone for luteal phase support during ICSI cycles, in terms of pregnancy outcomes and patient acceptability. The study included (80) infertile patients from those attending the Assisted Reproduction Technology Unit (ARTU) of Ain Shams University Maternity Hospital and a private center seeking for ICSI. There were no significant statistical differences between the study groups as regards chemical pregnancy rates and clinical pregnancy rates (P not significant). On the other hand, there were significant statistical differences between the study groups as regards overall acceptability and compliance, a better compliance of the rectal progesterone due to the easier application and the lesser local side effects registered.