title: Progesterone for Luteal Phase Support in In Vitro Fertilization: Comparison of Vaginal and Rectal Pessaries to Vaginal Capsules: A Randomized Controlled Study.
abstract: BACKGROUND
  In IVF, Luteal phase support is usually performed using vaginal progesterone. A part of patients using this route reports being uncomfortable with this route. We tried to study whether the rectal route could be an effective alternative and associated with less discomfort.
  
  
  METHODS
  A prospective randomized controlled study. All patient were eligible for IVF treatment for infertility. After oocyte pickup, 186 patients were allocated to one the following protocols for luteal phase support: (i) rectal pessaries group: natural progesterone pessaries administered rectally 200 mg three times a day, (ii) vaginal pessaries group: natural progesterone pessaries administered vaginally 200 mg three times a day), and (iii) vaginal capsules group: natural micronized progesterone capsules administered vaginally 200 mg three times a day. On the day of pregnancy test, patients were asked to fill in a questionnaire conducted by an investigator in order to assess the tolerability and side effects of the LPS treatment taken. The primary endpoint was the occurrence of perineal irritation.
  
  
  RESULTS
  Fifty eight patients were assigned to the rectal pessaries group, 68 patients to the vaginal pessaries group, and 60 patients to the vaginal capsules group. All patients adhered to their allocated treatment. Implantation and clinical pregnancy rates per transfer did not differ between the three groups. Perineal irritation, which was our primary endpoint, was the same for all the three groups (respectively 1.7 % versus 5.9 % versus 11.7%). Regarding the other side effects, more patients experienced constipation and flatulence with the rectal route, whereas more patients reported vaginal discharge in the vaginal capsules group.
  
  
  CONCLUSIONS
  Rectal administration for luteal phase support is effective and well accepted alternative to vaginal route.
authors.affiliation: Professor Associate, ART Center Aziza Othmana Hospital, Faculté de Médecine de Tunis, Université Tunis Manar, Tunisia.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Khrouf
authors.affiliation: MD, ART Center Aziza Othmana Hospital, Faculté de Médecine de Tunis, Université Tunis Manar, Tunisia.
authors.forename: Soufiene
authors.initials: S
authors.lastname: Slimani
authors.affiliation: Professor Associate, Pharmacy Department, CNGMO, Pharmacology Department of Faculté de Pharmacie de Monastir, Université du Centre, Monastir, Tunisia.
authors.forename: Myriam Razgallah
authors.initials: MR
authors.lastname: Khrouf
authors.affiliation: MD, ART Center Aziza Othmana Hospital, Faculté de Médecine de Tunis, Université Tunis Manar, Tunisia.
authors.forename: Marouen
authors.initials: M
authors.lastname: Braham
authors.affiliation: MD, ART Center Aziza Othmana Hospital, Faculté de Médecine de Tunis, Université Tunis Manar, Tunisia.
authors.forename: Maha
authors.initials: M
authors.lastname: Bouyahia
authors.affiliation: MD, Department of Reproductive Biology and Cytogenetic, Aziza Othmana Hospital, Faculté de Médecine de Tunis, Université Tunis Manar, Tunisia.
authors.forename: Khadija Kacem
authors.initials: KK
authors.lastname: Berjeb
authors.affiliation: Professor, Department of Reproductive Biology and Cytogenetic, Faculté de Médecine de Tunis, Université Tunis Manar, Tunisia.
authors.forename: Hanene Elloumi
authors.initials: HE
authors.lastname: Chaabane
authors.affiliation: Professor, Department of Reproductive Biology and Cytogenetic Aziza Othmana Hospital, Faculté de Pharmacie de Monastir, Université du Centre, Monastir, Tunisia.
authors.forename: Ghaya
authors.initials: G
authors.lastname: Merdassi
authors.affiliation: Embryologist, Assisted Conception Unit, Guy's Hospital, UK.
authors.forename: Aida Zahaf
authors.initials: AZ
authors.lastname: Kaffel
authors.affiliation: Professor, Department of Reproductive Biology and Cytogenetic Aziza Othmana Hospital, Faculté de Pharmacie de Monastir, Université du Centre, Monastir, Tunisia.
authors.forename: Amel
authors.initials: A
authors.lastname: Zhioua
authors.affiliation: Professor, Head of Department, ART Center Aziza Othmana Hospital, Faculté de Médecine de Tunis, Université Tunis Manar, Tunisia.
authors.forename: Fethi
authors.initials: F
authors.lastname: Zhioua
keywords: IVF; luteal phase support; progesterone; rectal route