Department of Reproductive Medicine, Sidra Medicine Hospital, Doha, Qatar.
Department of Obstetrics and Gynaecology, Aberdeen Royal Infirmary, Aberdeen Maternity Hospital, Aberdeen, UK.
Arch Gynecol Obstet. 2023 Aug;308(2):341-350. doi: 10.1007/s00404-022-06674-2. Epub 2022 Aug 9.
To investigate the optimal route of progesterone administration for luteal phase support in a frozen embryo transfer.
Systematic review.
Women undergoing frozen embryo transfer (FET).
We conducted an extensive database search of Medline (PubMed), Embase, Web of Science, and Cochrane Trials Register using relevant keywords and their combinations to find randomized controlled trials (RCTs) comparing the routes (i.e., oral, vaginal, intramuscular) of progesterone administration for luteal phase support (LPS) in artificial FET.
Clinical pregnancy, live birth, miscarriage.
Four RCTs with 3245 participants undergoing artificial endometrial preparation (EP) cycles during FET were found to be eligible. Four trials compared vaginal progesterone with intramuscular progesterone and two trials compared vaginal progesterone with oral progesterone. One study favored of vaginal versus oral progesterone for clinical pregnancy rates (RR 0.45, 95% CI 0.22-0.92) and other study favored intramuscular versus vaginal progesterone for clinical pregnancy rates (RR 1.46, 95% CI 1.21-1.76) and live birth rates (RR 1.62, 95% CI 1.28-2.05). Tabulation of overall evidence strength assessment showed low-quality evidence on the basis that for each outcome-comparison pair, there were deficiencies in either directness of outcome measurement or study quality.
There was little consensus and evidence was heterogeneous on the optimal route of administration of progesterone for LPS during FET in artificial EP cycles. This warrants more trials, indirect comparisons, and network meta-analyses.
CRD42021251017.
探讨冻融胚胎移植中黄体支持的孕激素最佳给药途径。
系统评价。
接受冻融胚胎移植（FET）的女性。
我们使用相关关键词及其组合对 Medline（PubMed）、Embase、Web of Science 和 Cochrane 临床试验注册库进行了广泛的数据库搜索，以查找比较黄体支持（LPS）中孕激素给药途径（即口服、阴道、肌肉注射）的随机对照试验（RCT）。
临床妊娠率、活产率、流产率。
发现 4 项 RCT 共纳入 3245 例接受人工子宫内膜准备（EP）周期 FET 的患者符合条件。4 项试验比较了阴道孕激素与肌肉注射孕激素，2 项试验比较了阴道孕激素与口服孕激素。一项研究表明阴道孕激素优于口服孕激素的临床妊娠率（RR 0.45，95%CI 0.22-0.92），另一项研究表明肌肉注射孕激素优于阴道孕激素的临床妊娠率（RR 1.46，95%CI 1.21-1.76）和活产率（RR 1.62，95%CI 1.28-2.05）。根据每个结局比较对的直接性结局测量或研究质量存在缺陷，总体证据强度评估的制表显示低质量证据。
在人工 EP 周期中，FET 中 LPS 孕激素最佳给药途径的共识很少，证据也存在异质性。这需要更多的试验、间接比较和网络荟萃分析。
PROPERO 编号：CRD42021251017。
