Meta-analysis of estradiol for luteal phase support in in vitro fertilization/intracytoplasmic sperm injection

ObjectiveTo evaluate whether the addition of E2 for luteal phase support (LPS) in IVF/intracytoplasmic sperm injection (ICSI) could improve the outcome of clinical pregnancy.DesignMeta-analysis.SettingUniversity hospital center.Patient(s)Women underwent IVF or ICSI using the GnRH agonist or GnRH antagonist protocol.Intervention(s)Progesterone alone or combined with E2 for LPS.Main Outcome Measure(s)Clinical pregnancy rate per patient (CPR/PA), clinical pregnancy rate per ET, implantation rate, ongoing pregnancy rate per patient, clinical abortion rate, and ectopic pregnancy rate.Result(s)Fifteen relevant randomized controlled trials (RCTs) were identified that included a total of 2,406 patients. There was no statistical difference between E2 + P group and P-only group regarding the primary outcome of CPR/PA for different routes of administration of E2 (oral, vaginal, and transdermal) or other relevant outcome measures. No significant effect was observed for different daily doses of E2 (6, 4, and 2 mg), even through oral medication in CPR/PA.Conclusion(s)The best available evidence suggests that E2 addition during the luteal phase does not improve IVF/ICSI outcomes through oral medication, even with different daily doses. Furthermore, RCTs that study other administration routes are needed.