Soliman, S., Daya, S., Collins, J., & Hughes, E. G. (1994). The role of luteal phase support in infertility treatment: a meta-analysis of randomized trials. Fertility and Sterility, 61(6), 1068-1076. https://doi.org/10.1016/s0015-0282(16)56758-2
Soliman S, Daya S, Collins J, Hughes EG. The role of luteal phase support in infertility treatment: a meta-analysis of randomized trials. Fertil Steril. 1994;61(6):1068-1076. doi:10.1016/s0015-0282(16)56758-2
Soliman, S., et al. "The role of luteal phase support in infertility treatment: a meta-analysis of randomized trials." Fertility and Sterility, vol. 61, no. 6, 1994, pp. 1068-1076.
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Luteal support after IVF raised pregnancy rates in a 1994 review
A 1994 meta-analysis of randomized trials found that progesterone luteal support raised pregnancy rates per cycle in IVF. The hormone hCG also helped when a GnRH agonist was used. Pooled trials showed no significant difference in miscarriage rates. Among IVF trials reporting it, about 5 out of 100 women given hCG developed moderate or severe ovarian hyperstimulation.
Key Findings
Progesterone or a progestagen raised the pregnancy rate per cycle in IVF across eight studies: common odds ratio 1.2 (95% CI 1.0 to 1.7).
With hCG in IVF cycles using a GnRH agonist, two trials gave an odds ratio of 4.2 (95% CI 1.9 to 9.1). Across all IVF cycles, heterogeneity left the benefit unestablished.
Within IVF cycles using a GnRH agonist, hCG was superior to progesterone: common odds ratio 2.0 (95% CI 1.1 to 3.9).
Luteal support did not significantly lower spontaneous abortion: odds ratio 0.8 (95% CI 0.4 to 1.7).
Moderate and severe ovarian hyperstimulation syndrome occurred in 5% (11/220) of women given hCG and in 0 of 193 given progesterone or no treatment.
Interpretation
The authors pooled trials in which only three described true randomization and ten assigned patients by alternate allocation. Trials of luteal support with other infertility therapies differed too much to combine, so the pooled conclusions apply to IVF cycles. The authors say more trials are needed on dose, route and timing, and on luteal support with other infertility therapies.
RRM Context
The authors link luteal support to IVF cycles using a GnRH agonist, where the corpus luteum develops poorly. The added hormone compensates for a problem the protocol creates. IVF bypasses the question of why conception fails. Restorative reproductive medicine evaluates the luteal phase in the woman's own cycle and treats its cause. NaProTechnology protocols use cycle-timed progesterone informed by charting.
Our editorial summary of this paper, not the article's abstract.
Abstract
Objective
To determine whether the use of luteal phase support improves pregnancy rate (PR) in infertility.
Design
A meta-analysis of randomized trials of luteal phase support. Search of the National Library of Medicine MEDLINE data base from 1971 using the words luteal, pregnancy, human, and comparative. Bibliography of relevant articles, reviews, and abstracts of scientific meetings were hand searched. All randomized controlled trials of luteal phase support in infertility were included. Luteal phase support for recurrent abortion and nonrandomized trials were excluded. The common odds ratio was calculated for each intervention using the Mantel-Haentzel test. Homogeneity of treatment effect was evaluated using the Breslow-Day test.
Main Outcome Measures
Pregnancy per cycle, rate of spontaneous abortion, and ovarian hyperstimulation syndrome rate.
Results
Eighteen trials met the above criteria. Human chorionic gonadotropin improved PRs in IVF when GnRH agonist (GnRH-a) was used (n = 151) and was superior to P (n = 352). Its benefit in all IVF cycles, however, was not established because of significant heterogeneity of treatment effect. Progesterone improved the PR in all IVF cycles (n = 457). No significant reduction in spontaneous abortion was noted with luteal support (n = 200). Ovarian hyperstimulation syndrome occurred in 5% of patients with hCG. Combination of data from trials of luteal support with other infertility therapies was not possible because of the differences in patient populations.
Conclusions
The meta-analysis supports the routine use of hCG in IVF cycles using a GnRH-a. Progesterone was also beneficial for luteal phase support in IVF. For other infertility therapy, however, further research is needed to evaluate the role of luteal phase support.
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