Efficacy of different forms of gestagens for luteal phase support in IVF protocols. A retrospective study

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Objective. To compare the efficacy of different forms of gestagen administration for luteal phase support in in vitro fertilization (IVF) protocols with gonadotropin-releasing hormone antagonists. Patients and methods. Data on ART cycles with “fresh” embryo transfers (day 5) were collected in a retrospective study. A total of 154 patients were divided into three groups. Group 1 (n = 100) received oral dydrogesterone 10 mg 3 times daily as luteal phase support (LPS), group 2 (n = 29) – subcutaneous progesterone 25 mg once daily, group 3 (n = 25) – micronized vaginal progesterone 200 mg 3 times daily. LPS was prescribed daily starting from the day of transvaginal ovarian puncture. At pregnancy onset, gestagens were continued until 12 weeks’ gestation. The primary efficacy endpoints were the rates of biochemical and clinical pregnancies, and the secondary endpoints were the rates of missed miscarriage and vaginal bleeding during early pregnancy. Results. The rates of biochemical pregnancy, clinical pregnancy, and missed miscarriage were comparable in the groups of oral dydrogesterone (38.00%), subcutaneous progesterone (37.93%) and micronized vaginal progesterone (36.00%), no statistically significant difference was found. There was a trend towards a lower risk of vaginal bleeding in the dydrogesterone (12.00%) and subcutaneous progesterone (13.79%) groups compared to the micronized vaginal progesterone group (24.00%), but the difference was not statistically significant (p = 0.694). Conclusion. Any of the presented forms of gestagens can be used in clinical practice, as the efficacy in all groups was comparable, with no statistically significant difference between them.