A comparison of the effects of three different luteal phase support protocols on in vitro fertilization outcomes: a randomized clinical trial

ObjectiveTo evaluate the effects of three different luteal phase support protocols on pregnancy and implantation rates, as well as luteal phase hormone profile in intracytoplasmic sperm injection–ET cycles.DesignA prospective, randomized study.SettingA tertiary teaching and research hospital.Patient(s)Two hundred eighty-eight patients who were undergoing intracytoplasmic sperm injection with a long protocol of controlled ovarian hyperstimulation.Intervention(s)Group 1 (E2 + P) received daily P plus 4 mg of E2, group 2 (hCG + P) received P plus 1,500 IU of hCG, and group 3 (P only) received daily vaginal P gel. Blood samples were drawn on the day of hCG administration, as well as 7 and 10 days after the hCG for the E2 and P measurements.Main Outcome Measure(s)The clinical pregnancy rate.Result(s)No difference existed between the E2 + P and hCG + P groups with respect to pregnancy rate, but it was significantly lower in the P-only group.The implantation rate was significantly lower in the P-only group than in the other groups.The highest miscarriage rate was in the P-only group (38%).Conclusion(s)In assisted reproductive technology cycles including treatment with GnRH agonist, adding 4 mg of oral E2 to P during the luteal phase significantly increased the pregnancy and implantation rates and decreased the miscarriage rate compared with the use of P only.