Die vaginale Anwendung von natürlichem Progesteron als Lutealphasenunterstützung nach IVF und Embryotransfer

Zusammenfassung

Die Notwendigkeit einer Lutealphasenunterstützung nach Embryotransfer im Rahmen der ovariellen Überstimulation und IVF gilt als gesichert. Zur Lutealphasenunterstützung können Progesteron (P) und humanes Choriongonadotropin (hCG) allein, in Kombination, oder in Kombinationen mit Östradiol (E2) auf verschiedenen Verabreichungswegen verwendet werden. Die gegenständliche systematische Übersichtsarbeit widmet sich der Frage, wie die Effizienz, im Sinne der klinischen Schwangerschaftsrate pro Embryotransfer, der vaginalen Verabreichung von natürlichem Progesteron in Form von Kapseln, Suppositorien und Vaginalcremes im Vergleich zu anderen Formen der Lutealphasenunterstützung, inklusive dem Crinone® 8 % Vaginalgel, ist. Zur Beantwortung dieser Frage wurde die vorliegende Literatur systematisch gesichtet und die relevanten Daten aus randomisierten Vergleichsstudien zur Lutealphasenunterstützung nach IVF‐ET einer quantitativen Datensynthese unterworfen. 24 Studien mit insgesamt 5334 Patientinnen in 33 Vergleichsgruppen konnten eingeschlossen werden. Die häufigsten Vergleichsgruppen waren: vaginales P als Kapsel/Suppositorium vs. 1) intra-muskuläres P (Odds Ratio [OR] 0,99 [95%-Konfidenzintervall {CI} 0,58 - 1,72]); 2) hCG (1,13 [0,84 - 1,52]); 3) vaginales P + hCG (1,02 [0,76 - 1,36]); 4) Crinone® 8 % (0,96 [0,76 - 1,22]); 5) vaginales P + orales E2 (1,03 [0,68 - 1,56]); und 6) oral verabreichtes P oder Gestagen (1,11 [0,69 - 1,76]). Die Studienergebnisse in den einzelnen Vergleichsgruppen waren homogen, mit Ausnahme des Vergleiches von vaginalem P vs. IM P. Die vorliegenden Literaturdaten indizieren keinen signifikanten Unterschied der Vergleichsgruppen hinsichtlich der Wahrscheinlichkeit einer klinischen Schwangerschaft nach IVF‐ET.

Abstract

The beneficial effect of luteal phase support after embryo transfer in IVF treatment (IVF-ET) has unequivocally been accepted. Various substances (human chorionic gonadotropin (hCG), progesterone (P), estradiol [E2]) and regimens of administration are employed. The present systematic review aims at determining the efficacy of administration of vaginal P as capsules, suppositories or vaginal cream versus other forms of luteal phase support (including Crinone® 8 % vaginal gel) after ovarian hyperstimulation and IVF‐ET. The available literature was reviewed and data on clinical pregnancy rates per embryo transfer was retrieved from randomised controlled trials. 24 studies with a total of 5334 randomized patients in 33 group comparisons were included in this review. In these studies, various doses of vaginal P as capsules/suppositories/vaginal cream in various administration regimens were evaluated. The following subgroups were identified: vaginal P vs. 1) intra-muscular P (odds ratio [OR] 0.99 [95 % confidence interval {CI} 0.58 - 1.72]); 2) hCG (1.13 [0.84 - 1.52]); 3) vaginal P + hCG (1.02 [0.76 - 1.36]); 4) Crinone® 8 % (0.96 [0.76 - 1.22]); 5) vaginal P + oral E2 (1.03 [0.68 - 1.56]); and 6) orally administered P or gestagen (1.11 [0.69 - 1.76]). Results of individual studies were homogenous in subgroup comparisons except for vaginal P vs. intra-muscular P. Current data from the literature indicate no significant difference between vaginal P as capsules/suppositories/cream as compared to a wide range of other forms of luteal phase support after IVF.

Progesteron - IVF - Lutealphase - Utrogest - Crinone

Progesterone - IVF - luteal phase - Crinone - Utrogest

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