Is There a Role for Estradiol With Progesterone in Luteal Phase Support With Intracytoplasmic Sperm Injection Cycles? A Retrospective Controlled Study With Reviewing the Literature

Abstract

Background: Luteal phase support (LPS) after intracytoplasmic sperm injection (ICSI) is a mandatory step. Progesterone is the standard LPS. There is a debate as regards the use of estradiol. The present study was conducted to evaluate the effect of adding estradiol to LPS on pregnancy rate in patients treated by ICSI.

Methods: A retrospective controlled study was conducted on 68 infertile females scheduled for ICSI through the luteal long agonist protocol. They were divided into two groups as regards the LPS: group 1 (control): 42 patients using progesterone injections intramuscular (100 mg daily) together with two vaginal pessaries 400 mg daily twice daily; group 2 (estradiol): 26 patients where midluteal oral 4 mg estradiol valerate tablet in addition to progesterone as group 1 was used. Clinical pregnancy rate was the primary outcome.

Results: There was no significant difference between the two studied groups as regards number of MII oocytes, the cleavage rate, number of embryos and number of class A embryos. As regards the pregnancy rate, it was higher in the estradiol group than in the control group but did not reach the statistical significance, 16 of 26 (61.5%) and 20 of 42 (47.6%) in the treated group versus non-treated group (P = 0.264).

Conclusion: Since estradiol level declines in the midluteal phase, patients could benefit from adding estradiol to progesterone in LPS, and at that time the effect of human chorionic gonadotropin (hCG) used for ovulation triggering on the corpus luteum decreases. The benefit includes an increase in the probability of pregnancy. There is a need for further RCTs that will assess the effect of estrogen addition to progesterone during the luteal phase on the probability of pregnancy.




J Clin Gynecol Obstet. 2015;4(2):226-231
doi: http://dx.doi.org/10.14740/jcgo333w