黃體期補充雌激素對IVF懷孕率並無明顯助益

黃體期補充雌激素對於GnRH antagonist+IVF療程之懷孕率並無明顯助益

http://humrep.oxfordjournals.org/content/21/10/2628.long

Addition of estradiol to progesterone for luteal supplementation in patients stimulated with GnRH antagonist/rFSH for IVF: a randomized controlled trial

1. H.M. Fatemi¹, 
2. E.M. Kolibianakis, 
3. M. Camus, 
4. H. Tournaye, 
5. P. Donoso,
6. E. Papanikolaou and 
7. P. Devroey

+Author Affiliations

1. Centre for Reproductive Medicine, Dutch-Speaking Free University Brussels, Laarbeeklaan, Brussels, Belgium

1. 1To whom correspondence should be addressed at: V.U.B/C.R.G., Laarbeeklaan 101, 1090 Brussels, Belgium. E-mail: hmousavi@az.vub.ac.be

• Received January 10, 2005.
• Revision received February 27, 2006.
• Accepted March 23, 2006.

Next Section

Abstract

BACKGROUND: The role of progesterone for luteal support in stimulated cycles for IVF is well established. However, controversy still surrounds the benefit of additional supplementation with estradiol (E₂) in GnRH agonist (GnRHa) cycles, while no such data are available for GnRH antagonists. The aim of this randomized controlled trial (RCT) was to compare ongoing pregnancy rates in patients stimulated with recombinant FSH (rFSH) and GnRH antagonist for IVF, who received micronized progesterone for luteal phase supplementation, with or without the addition of E₂. METHODS: Two hundred and one patients underwent ovarian stimulation with a fixed dose of 200 IU rFSH and GnRH antagonist. Patients were randomized to receive, for luteal phase supplementation, either 600 mg of micronized progesterone vaginally (n = 100, progesterone group) or 600 mg of micronized progesterone and 4 mg of E₂ valerate orally (n = 101, progesterone/E₂ group). The main outcome measure was ongoing pregnancy at 12 weeks per patient randomized. RESULTS: Demographics, stimulation parameters and embryological data were comparable for the two groups compared. Twenty-six ongoing pregnancies were achieved in the progesterone (26%) and 30 in the progesterone/E₂ group (29.7%). (Difference: 3.7 and 95%, CI: −15.8 to 8.6%). CONCLUSION: It appears that the addition of E₂ to progesterone in the luteal phase after stimulation with rFSH and GnRH antagonist does not enhance the probability of pregnancy.

Table III.

Achievement of pregnancy in the two groups randomized

	Progesterone group (%)	Progesterone (%)/E2group	Pvalue	Difference in ongoing pregnancy rate (%) (95% CI)
Ongoing pregnancy/patient randomized	26 (26/100)	29.7 (30/101)	0.64	3.7 (–15.8 to +8.6)
Ongoing pregnancy per oocyte retrieval	26.8 (26/97)	30.3 (30/99)	0.64	3.5 (–15.9 to +9.1)
Ongoing pregnancy per embryo transfer	28.9 (26/90)	32.6 (30/92)	0.633	7 (–16.8 to +9.6)
Early pregnancy lossa	23.4 (8/34)	23.1 (9/39)	1	0.4 (–18.4 to +19.9)

• No significant differences were observed between the groups compared.
• ↵a Biochemical pregnancies, ectopic pregnancies and first trimester abortions.