A meta-analysis of the route of administration of luteal phase support in assisted reproductive technology: vaginal versus intramuscular progesterone.
OBJECTIVE
To perform an analysis of data with consideration for the current clinically accepted vaginal progesterone (P) or intramuscular (IM) P dosing regimens and the clinically relevant randomized clinical trials published during the time frame 1992 to 2008.


METHODS
Meta-analysis of progesterone luteal support in IVF cycles using odds ratios (OR) and 95% confidence intervals (CI).


METHODS
Previously conducted randomized clinical trials meeting acceptance criteria.


METHODS
Infertility patients.


METHODS
Progesterone (50 mg) IM daily or 200 mg P-in-oil capsules three times a day vaginally or 90 mg P in bioadhesive gel daily vaginally.


METHODS
Clinical pregnancy, ongoing pregnancy, miscarriage.


RESULTS
This analysis showed a comparable effect between vaginal progesterone as an oil-in-capsule or as a bioadhesive gel and IM P administration on the endpoints of clinical pregnancy (OR = 0.91, 95% [CI 0.74, 1.13]) and ongoing pregnancy (OR = 0.94, 95% [CI 0.71, 1.26]). A nominally significantly lower rate of miscarriage was observed with vaginal P compared with IM P (OR = 0.54, 95% [CI 0.29, 1.02]).


CONCLUSIONS
Administration of vaginal P is comparable to administration of IM P for luteal phase support in assisted reproductive technology.
Zarutskie
Paul W
PW
Zarutskie Fertility and Endocrine Institute, 1916 Pike Place, Seattle, WA 98101, USA. pwzlnca@aol.com
Phillips
James A
JA
D000282:Administration, Intravaginal; D000284:Administration, Oral; D002214:Capsules; D003338:Corpus Luteum / Q000187:drug effects / Q000502:physiology*; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods*; D006801:Humans; D007273:Injections, Intramuscular; D016017:Odds Ratio; D011247:Pregnancy; D011374:Progesterone / Q000008:administration & dosage* / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D027724:Reproductive Techniques, Assisted / Q000592:standards*
D002214:Capsules; D011374:Progesterone