受精ジャーナル:体外受精 - 体外受精 - 世界中、生殖医学、遺伝学、幹細胞生物学
オープンアクセス
ISSN: 2375-4508
ISSN: 2375-4508
Ameet Patki, Hrishikesh Pai, Duru Shah, Sonia Malik, Kamini Rao
Objectives: To determine the comparative efficacy of oral Dydrogesterone (DYD) with Vaginal Progesterone (VP)/ Intramuscular Progesterone (IMP) for Luteal-Phase Support (LPS) in women undergoing Frozen Embryo Transfer (FET): By a systematic review and meta-analysis based on all original research published in PubMed, Web of Science, Scopus, CINAHL complete, and Embase up till 26th October 2022. The protocol was registered with Prospero (CRD42022372123 Title: Evaluating the role of oral DYD for luteal-phase support in women undergoing frozen embryo transfer: Systematic review with Meta-analysis. Last Edited: 12/11/2022).
Methods: Following PRISMA 2020 guidelines under a PICOS framework, we included original articles on women undergoing FET, receiving luteal phase support (Population), with either oral DYD (Intervention) or Vaginal Progsesterone (VP)/Intramuscular Progesterone (IMP) (Comparators), measuring pregnancy rate miscarriage rate, live birth rate, patient satisfaction, and side effects (Outcomes)
Results: Of 366 studies identified, 30 full-text articles were selected. Out of these 30 articles, 22 were excluded for varied reasons. Therefore, this FET meta-analysis included 8 articles covering oral DYD as an intervention, (n=3051) and comparators (n=2174) consisting of VP (n=690) and IMP (n=1484). Pooled data from both RCTs and observational studies showed that clinical pregnancy, live births and miscarriage did not differ significantly between oral DYD and VP/IMP groups. Women on oral DYD reported significantly higher patient satisfaction scores than on VP (4.09 ± 0.96 vs. 3.36 ± 1.23; P=0.001). Likewise, women experiencing at least one side effect were the fewest among those who received DYD (7.7% on DYD, 16.4% on VP, and 52.3% on IMP). Only 1.9% on DYD experienced moderate to severe side effects vs. 5.5% on VP and 29.5% on IMP. Side effects forced eight women to discontinue IM progesterone.
Conclusions: Fewer side effects and demonstration of non-inferiority in clinical outcomes make oral DYD a better option than VP and IM progesterone for LPS in women undergoing FET procedure for IVF.