Oral dydrogesterone vs. vaginal progesterone capsules for luteal-phase support in women undergoing embryo transfer: a systematic review and meta-analysis

To identify, appraise, and summarize the evidence from randomized controlled trials (RCTs) comparing oral dydrogesterone to vaginal progesterone capsules for luteal-phase support (LPS) in women offered fresh or frozen embryo transfers following in vitro fertilization. Two independent authors screene...

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Bibliographic Details
Published in:	JBRA assisted reproduction Vol. 22; no. 2; pp. 148 - 156
Main Authors:	Barbosa, Marina Wanderley Paes, Valadares, Natália Paes Barbosa, Barbosa, Antônio César Paes, Amaral, Adelino Silva, Iglesias, José Rubens, Nastri, Carolina Oliveira, Martins, Wellington de Paula, Nakagawa, Hitomi Miura
Format:	Journal Article
Language:	English
Published:	Brazil Sociedade Brasileira de Reprodução Humana (Brazilian Society of Assisted Reproduction) 01-01-2018 Brazilian Society of Assisted Reproduction
Subjects:	Administration, Intravaginal Administration, Oral Adult Bioavailability Clinical trials Corpus Luteum Maintenance - drug effects Dydrogesterone - administration & dosage Dydrogesterone - adverse effects Dydrogesterone - therapeutic use Embryo Transfer Embryos Evidence-based medicine Female Humans In vitro fertilization Meta-analysis Miscarriage Pregnancy Progesterone - administration & dosage Progesterone - adverse effects Progesterone - therapeutic use Progestins - administration & dosage Progestins - adverse effects Progestins - therapeutic use Randomized Controlled Trials as Topic Review Systematic review Womens health Brazil IVF meta-analysis luteal phase support dydrogesterone
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Summary:	To identify, appraise, and summarize the evidence from randomized controlled trials (RCTs) comparing oral dydrogesterone to vaginal progesterone capsules for luteal-phase support (LPS) in women offered fresh or frozen embryo transfers following in vitro fertilization. Two independent authors screened the literature for papers based on titles and abstracts, then selected the studies, extracted data, and assessed the risk of bias. Dydrogesterone and progesterone were compared based on risk ratios (RR) and the precision of the estimates was assessed through the 95% confidence interval (CI). An electronic search performed on June 7, 2017 retrieved 376 records, nine of which were papers deemed eligible and included in this systematic review and quantitative analysis. Good quality evidence indicates that oral dydrogesterone provided at least similar results than vaginal progesterone capsules on live birth/ongoing pregnancy (RR=1.08, 95%CI=0.92-1.26, I2=29%, 8 RCTs, 3,386 women) and clinical pregnancy rates (RR 1.10, 95% CI 0.95 to 1.27; I2=43%; 9 RCTs; 4,061 women). Additionally, moderate quality evidence suggests there is no relevant difference on miscarriage rates (RR=0.92, 95%CI=0.68-1.26, I2=6%, 8 RCTs, 988 clinical pregnancies; the quality of the evidence was downgraded because of imprecision). Good quality evidence from RCTs suggest that oral dydrogesterone provides at least similar reproductive outcomes than vaginal progesterone capsules when used for LPS in women undergoing embryo transfers. Dydrogesterone is a reasonable option and the choice of either of the medications should be based on cost and side effects.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23 ObjectType-Undefined-3
ISSN:	1518-0557 1517-5693 1518-0557
DOI:	10.5935/1518-0557.20180018