Subcutaneous Progesterone Is Effective and Safe for Luteal Phase Support in IVF: An Individual Patient Data Meta-Analysis of the Phase III Trials

PLoS One. 2016 Mar 18;11(3):e0151388. doi: 10.1371/journal.pone.0151388. eCollection 2016.

Abstract

Objective: To summarize efficacy and safety data on a new progesterone compound which is available for subcutaneous administration as compared to vaginally administered progesterone for luteal phase support in patients undergoing IVF treatment.

Design: Data from two randomized phase III trials (07EU/Prg06 and 07USA/Prg05) performed according to GCP standards with a total sample size of 1435 per-protocol patients were meta-analyzed on an individual patient data level.

Setting: University affiliated reproductive medicine unit.

Patients: Subcutaneous progesterone was administered to a total of 714 subjects and vaginal progesterone was administered to a total of 721 subjects who underwent fresh embryo transfer after ovarian stimulation followed by IVF or ICSI. The subjects were between 18 and 42 years old and had a BMI <30 kg/m2.

Interventions: Subcutaneous progesterone 25 mg daily vs. either progesterone vaginal gel 90 mg daily (07EU/Prg06) or 100 mg intravaginal twice a day (07USA/Prg05) for luteal phase support in IVF patients.

Main outcome measures: Ongoing pregnancy rate beyond 10 gestational weeks, live birth rate and OHSS risk.

Results: The administration of subcutaneous progesterone versus intra-vaginal progesterone had no impact on ongoing pregnancy likelihood (OR = 0.865, 95% CI 0.694 to 1.077; P = n.s.), live birth likelihood (OR = 0.889, 95% CI 0.714 to 1.106; P = n.s.) or OHSS risk (OR = 0.995, 95% CI 0.565 to 1.754; P = n.s.) in regression analyses accounting for clustering of patients within trials, while adjusting for important confounders. Only female age and number of oocytes retrieved were significant predictors of live birth likelihood and OHSS risk.

Conclusion: No statistical significant or clinical significant differences exist between subcutaneous and vaginal progesterone for luteal phase support.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Intravaginal
  • Adult
  • Birth Rate
  • Clinical Trials, Phase III as Topic
  • Embryo Transfer
  • Female
  • Fertilization in Vitro / methods*
  • Humans
  • Live Birth
  • Luteal Phase / drug effects*
  • Luteal Phase / physiology
  • Ovarian Hyperstimulation Syndrome / epidemiology
  • Ovarian Hyperstimulation Syndrome / etiology
  • Ovulation Induction / methods
  • Pregnancy
  • Pregnancy Rate
  • Progesterone / administration & dosage*
  • Progesterone / therapeutic use*
  • Treatment Outcome

Substances

  • Progesterone

Grant support

Support for this work was provided by IBSA Institute Biochimique SA http://www.ibsa.ch. The funder provided support in the form of salaries for author [GG], but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of the authors are articulated in the Author Contributions section.