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Comparison of four protocols for luteal phase support in frozen-thawed Embryo transfer cycles: a randomized clinical trial

  • Gynecologic Endocrinology and Reproductive Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To compare the pregnancy outcomes between four regimens of luteal phase support (LPS), including vaginal progesterone, oral dydrogesterone, combination of oral dydrogesterone and gonadotropin releasing hormone analog (GnRH-α), and combination of oral dydrogesterone and human chorionic gonadotrophin (hCG), in Frozen-thawed Embryo Transfer (FET) cycles.

Methods

This randomized clinical trial was performed during a 6-month period, including candidates for FET. Patients were randomly assigned to four groups for LPS: 400 mg vaginal progesterone suppository twice daily, 10 mg oral dydrogesterone twice daily, 10 mg oral dydrogesterone twice daily combined with injection of 0.1 mg GnRH-α, and 10 mg oral dydrogesterone twice daily combined with injection of 1500 IU hCG. Primary endpoint included clinical pregnancy rate, ongoing pregnancy rate (OPR), and miscarriage rate (MR).

Results

A total of 400 FET cycles were analyzed. CPR was significantly lower in dydrogesterone group (9 %) when compared to vaginal progesterone (20 %), dydrogesterone and GnRH-α (25 %), and dydrogesterone and hCG (17 %). Logistic regression showed that only dydrogesterone group had significantly lower CPR in comparison with vaginal progesterone (OR = 0.39; p = 0.03), while it was comparable between other three groups. There were no significant difference between four groups regarding to OPR and MR.

Conclusion

Vaginal progesterone provides appropriate LPS. Yet, combination of oral dydrogesterone and GnRH-α or hCG can be more suitable option compared to vaginal progesterone for LPS in women with vaginal irritation or discharge at a lower cost.

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Authors and Affiliations

  1. Infertility Research Center, Department of Obstetrics and Gynecology, Shiraz University of Medical Sciences, Shiraz, Iran

    Afsoon Zarei, Parastoo Sohail, Mohammad Ebrahim Parsanezhad, Saeed Alborzi, Alamtaj Samsami & Maryam Azizi

  2. Department Office, Mother & Child Hospital, Quran Gate, Shiraz, 7134844119, Iran

    Parastoo Sohail

Authors
  1. Afsoon Zarei
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  2. Parastoo Sohail
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  3. Mohammad Ebrahim Parsanezhad
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  4. Saeed Alborzi
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  5. Alamtaj Samsami
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  6. Maryam Azizi
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Corresponding author

Correspondence to Parastoo Sohail.

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Funding

This study was funded by granny from vice chancellor of research of Shiraz University of Medical Sciences (Grant No. 1376-52-21).

Conflict of interest

None of the authors have any conflict of interest to declare regarding the manuscript.

Ethical approval

All procedures performed in the current study were in accordance with the ethical standards of the Shiraz University of Medical Sciences and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Zarei, A., Sohail, P., Parsanezhad, M.E. et al. Comparison of four protocols for luteal phase support in frozen-thawed Embryo transfer cycles: a randomized clinical trial. Arch Gynecol Obstet 295, 239–246 (2017). https://doi.org/10.1007/s00404-016-4217-4

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  • DOI: https://doi.org/10.1007/s00404-016-4217-4

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