EJMS

Abstract

Background: Abnormal progesterone profiles were frequently observed in the luteal phase following GnRH-agonist-induced ICSI cycles. Lower progesterone levels were closely related to poor implantation and pregnancy outcomes. Several formulas, doses, and routes of progesterone and hCG supplements were used to overcome the hypothesized sub-optimal steroid environment. Few studies clarified the efficacy of luteal supplements in correcting luteal steroid profiles. This study aimed to assess the effect of progesterone supplements compared to hCG injection in maintaining the luteal phase in GnRH-agonist-induced ICSI Cycles.
Methods: This prospective controlled trial was conducted in El-Sahel Teaching Hospital between 2009 and 2011. The study included 152 pregnant after ICSI cycles with GnRH-Agonist superovulation. They were randomized to receive oral micronized progesterone 200 mg daily (n=51), rectal progesterone suppositories 400 mg twice daily (n=55) subjects received two times daily 400 mg rectal progesterone suppositories, or intramuscular hCG 5000 IU once daily (n=46). Forty-two natural pregnancy cases were used as a control group. Plasma progesterone levels were measured on days 1, 7, and 14 of embryo transfer and on the missed period and pregnancy documentation day in the control group.
Results: Luteal phase progesterone level was significantly lower in induced compared to natural cycles. Progesterone supplementation caused no significant differences in plasma progesterone concentrations (24-31 nmol/l). Although hCG injection induced better stabilization of progesterone profiles at day 7 with a mean of 317.7 nmol/l, however, its effect was not statistically significant later on.
Conclusion Various progesterone forms delivered a relatively small amount of progesterone to the circulation independent of the dose and preparation. hCG did not improve the pregnancy outcome, despite its greater ability to optimize the hormonal environment than progesterone supplement at first doses. Implantation and pregnancy rate with either progesterone supplements or hCG injections were similar.