The effect of luteal phase vaginal estradiol supplementation on the success of in vitro fertilization treatment: a prospective randomized study.
OBJECTIVE
To determine whether the use of luteal phase vaginal E(2) supplementation improves clinical pregnancy rates in patients undergoing IVF treatment.


METHODS
Prospective randomized controlled trial.


METHODS
University-based tertiary fertility center.


METHODS
One hundred sixty-six patients undergoing their first cycle of IVF treatment.


METHODS
Patients underwent three different protocols for controlled ovarian hyperstimulation for IVF treatment with long GnRH agonist suppression, use of GnRH antagonist, or a microdose GnRH agonist protocol. Luteal phase support was in the form of IM P. Patients randomized into the study group (n = 84) received E(2) supplementation in the form of vaginal estrace 2 mg twice a day starting on the day of ET. Patients randomized to the control group (n = 82) received no E(2) supplementation.


METHODS
Clinical pregnancy rates.


RESULTS
There were no significant differences in the implantation (56/210 [26.7%] vs. 64/203 [31.5%]), clinical pregnancy (42/84 [50%] vs. 52/82 [63.4%]), and ongoing pregnancy rates (40/84 [47.6%] vs. 46/82 [56.1%]) between the study and control groups, respectively. In the subgroup of patients who used the long GnRH agonist suppression protocol, there was a lower clinical pregnancy rate in the study group compared with the control group (27/55 [49.1%] vs. 42/59 [71.2%]). There were, however, no differences in clinical pregnancy rates between the two groups in patients who used either the GnRH antagonist or microdose GnRH agonist protocols.


CONCLUSIONS
The addition of vaginal E(2) supplementation to routine P supplementation for luteal support does not improve the probability of conception after IVF treatment.
Center for Advanced Reproductive Services, Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Connecticut Health Center, Farmington, CT 06030-6224, USA. lengmann@uchc.edu
Lawrence
L
Engmann
Andrea
A
DiLuigi
David
D
Schmidt
Claudio
C
Benadiva
Donald
D
Maier
John
J
Nulsen
D000282:Administration, Intravaginal; D000328:Adult; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D010064:Embryo Implantation / Q000187:drug effects; D004958:Estradiol / Q000008:administration & dosage*; D005260:Female; D005300:Fertility Agents, Female / Q000008:administration & dosage*; D005306:Fertilization / Q000187:drug effects; D005307:Fertilization in Vitro; D007987:Gonadotropin-Releasing Hormone / Q000008:administration & dosage / Q000819:agonists / Q000031:analogs & derivatives / Q000037:antagonists & inhibitors; D006727:Hormone Antagonists / Q000008:administration & dosage; D006801:Humans; D007246:Infertility / Q000503:physiopathology / Q000628:therapy*; D016729:Leuprolide / Q000008:administration & dosage; D008183:Luteal Phase; D010062:Ovulation Induction; D011247:Pregnancy; D018873:Pregnancy Rate; D011374:Progesterone / Q000008:administration & dosage; D011446:Prospective Studies; D020554:Sperm Injections, Intracytoplasmic; D016896:Treatment Outcome
D005300:Fertility Agents, Female; D006727:Hormone Antagonists; D007987:Gonadotropin-Releasing Hormone; D011374:Progesterone; D004958:Estradiol; D016729:Leuprolide; C061018:ganirelix