title: Estrogen supplementation to progesterone as luteal phase support in patients undergoing in vitro fertilization: systematic review and meta-analysis.
abstract: Meta-analyses have found conflicting results with respect to the use of progesterone or progesterone plus estrogen as luteal phase support for in vitro fertilization (IVF) protocols involving gonadotropins and/or gonadotropin-releasing hormone analogs. The aim of the present study was to perform an updated meta-analysis on the efficacy of progesterone versus progesterone plus estrogen as luteal phase support. We searched the MEDLINE, Cochrane Library, and Google Scholar databases (up to March 18, 2014). The search terms were (estrogen OR estradiol OR oestradiol) AND (progesterone) AND (IVF OR in vitro fertilization) AND (randomized OR prospective). We did not limit the form of estrogen and included subjects who contributed more than 1 cycle to a study. The primary outcome was clinical pregnancy rate. Secondary outcomes were ongoing pregnancy rate, fertilization rate, implantation rate, and miscarriage rate. A total of 11 articles were included in the present analysis, with variable numbers of studies assessing each outcome measure. Results of statistical analyses indicated that progesterone plus estrogen treatment was more likely to result in clinical pregnancy than progesterone alone (pooled odds ratio 1.617, 95% confidence interval 1.059-2.471; P = 0.026). No significant difference between the 2 treatment regimens was found for the other outcome measures. Progesterone plus estrogen for luteal phase support is associated with a higher clinical pregnancy rate than progesterone alone in women undergoing IVF, but other outcomes such as ongoing pregnancy rate, fertilization rate, implantation rate, and miscarriage rate are the same for both treatments.
authors.affiliation: From the Reproductive Medicine Center (X-MZ, FL, PW, X-MH, K-FL, YP, N-JD, Y-RJ, HS), Department of Obstetrics and Gynecology, Northern Jiangsu People's Hospital, Yangzhou University, Yangzhou, Jiangsu; and Reproductive Medicine Center (RH), Key Laboratory of Fertility Preservation and Maintenance of Ministry of Education, Ningxia Medical University, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China.
authors.forename: Xiao-Mei
authors.initials: XM
authors.lastname: Zhang
authors.forename: Fang
authors.initials: F
authors.lastname: Lv
authors.forename: Pin
authors.initials: P
authors.lastname: Wang
authors.forename: Xia-Man
authors.initials: XM
authors.lastname: Huang
authors.forename: Kai-Feng
authors.initials: KF
authors.lastname: Liu
authors.forename: Yu
authors.initials: Y
authors.lastname: Pan
authors.forename: Nai-Jun
authors.initials: NJ
authors.lastname: Dong
authors.forename: Yu-Rong
authors.initials: YR
authors.lastname: Ji
authors.forename: Hong
authors.initials: H
authors.lastname: She
authors.forename: Rong
authors.initials: R
authors.lastname: Hu
mesh_terms: D000022:Abortion, Spontaneous; D010064:Embryo Implantation / Q000187:drug effects; D004967:Estrogens / Q000008:administration & dosage*; D005260:Female; D005306:Fertilization / Q000187:drug effects; D005307:Fertilization in Vitro; D006801:Humans; D008183:Luteal Phase / Q000187:drug effects*; D011247:Pregnancy; D018873:Pregnancy Rate; D011374:Progesterone / Q000008:administration & dosage*; D011372:Progestins / Q000008:administration & dosage*
chemical_list: D004967:Estrogens; D011372:Progestins; D011374:Progesterone