Progesterone supplementation during cryopreserved embryo transfer cycles: efficacy and convenience of two vaginal formulations

Sequential exogenous oestradiol and progesterone are often used to prepare the endometrium in frozen embryo transfer (FET) cycles. This open-label, randomized study compared the efficacy and acceptability of self-administered once daily vaginal progesterone gel and vaginal micronized progesterone tablets (three times daily) for luteal support in FET cycles. An Asian population of women (aged ≥45 years) were assigned randomly to receive progesterone gel (90 mg, once daily, n = 100) or vaginal micronized progesterone tablets (200 mg, three times daily, n = 100). All received oestradiol from day 2 of the menstrual cycle, for at least 10 days (or until endometrial thickness was ≥8 mm), before self-administering progesterone for 2 days before FET and up to 14 weeks afterwards if pregnancy occurred. Clinical pregnancy rates (31% for gel and 28% for tablets) and implantation rates (9.8% and 8.8%, respectively) were not significantly different between the treatment groups. Asian women using once daily progesterone gel found the gel easy to use and comfortable, and preferred it to their previous experience of vaginally administered tablets. In summary, once-daily vaginal progesterone gel has similar efficacy to vaginal tablets and is associated with high patient satisfaction.