Luteal phase support in in-vitro fertilization

Objective: To compare the clinical pregnancy rate after the use of human chorionic gonadotropin (hCG) injections(Profasi, Serono Pharmaceuticals), to that after the use of oral Duphaston (Duphaston, Solvay Pharmaceuticals B.V.,Weesp, The Netherlands) , or vaginal Cyclogest (Cyclogest, Cox Pharmaceuticals, Barnstaple, Ex32 8NS, England)used for luteal phase support in in-vitro fertilization-embryo transfer (IVF-ET) cycles using gonadotropin- releasing hormone agonist.Study design: A retrospective cohort study.Setting: Tawam Hospital Fertility Clinic (a tertiary referral center) in the United Arab Emirates.Materials and methods: A total of 305 consecutive IVF/ET cycles from 1st of January to 31st of May 2000 were included in the study. All women were 40 years of age. 201 women were treated with hCG (66%) at a dose of1,500-2,500 IU intramuscular (IM) given every second or third day for three to five doses. 44 women were treated with oral Duphaston (14.4%) given at a dose of 40mg/day and 60 were given vaginal Cyclogest pessaries (19.6%)at a dose of 400 mg twice daily, until the date of the pregnancy test. Student t test was used for statistical analysis to measure significance.Main outcome measures: Clinical pregnancy rate.Results: The use of IM hCG for luteal phase support in IVF-ET cycles was associated with similar clinical pregnancyrate compared with vaginal Cyclogest pessaries and oral progesterone (Duphaston) (24.9%, 28.3% and 25%respectively), (P=1.000and P= 0.359).Conclusion: There is no significant difference in clinical pregnancy rate when different modalities of luteal phase support medications are used in IVF-ET cycles like hCG, oral Duphaston and vaginal Cyclogest. This conclusion is affected by the small number of studied cycles and the study design being retrospective.