Biomedical subjects
Publications and source records attributed to Alan S Penzias.
Confusion is common when trying to compare the outcome of different fertility treatments. Calculation of fecundability is an excellent adjunct to reports that show cumulative conception totals after a period of observation or treatment.
A large percentage of patients discontinues infertility treatment despite a reasonable prognosis and benefits that cover the costs. Recognition of this problem and appropriate intervention may play a role in helping couples remain in treatment.
OBJECTIVE: To develop a consensus regarding the need for luteal phase support during assisted reproductive technology (ART), and to establish the optimal compound and route of administration for this purpose. DESIGN: Review of the published literature on luteal phase support. PATIENT(S): Women undergoing assisted reproductive technologies. INTERVENTION(S): Progesterone was administered orally, vaginally, or by intramuscular (i.m.) injection to supplement the luteal phase after assisted reproductive technology (ART). MAIN OUTCOME MEASURE(S): Pregnancy following ART. RESULT(S); Gonadotropin releasing hormone (GnRH)-agonist protocols necessitate the use of luteal phase support. Progesterone and human chorionic gonadotrophin (hCG) have both been used for this purpose, with comparable outcomes. Progesterone is the product of choice, however, as it is associated with a lower incidence of ovarian hyperstimulation syndrome (OHSS). Its use is indicated up to the serum pregnancy test. Oral, i.m., and vaginal progesterone preparations are available. Intramuscular and vaginal preparations lead to comparable rates of implantation and clinical pregnancy, despite higher serum progesterone levels after i.m. injection. Oral formulations are inferior products for luteal support. Although widely used, i.m. progesterone is uncomfortable and inconvenient for patients. By contrast, the vaginal progesterone gel (Crinone 8%) is more convenient and easier to use. CONCLUSION(S): Progesterone support of the luteal phase in in vitro fertilization (IVF) cycles is indicated, though support beyond the serum pregnancy test may not be needed. The pregnancy rates after vaginal and i.m. progesterone support are comparable, despite higher serum levels after i.m. injection. Patients prefer the vaginal progesterone gel.
The purpose of this study was to review the rationale for vaginal progesterone treatment as luteal support in IVF, and the clinical experience with vaginal micronized progesterone gel. It was found that luteal support with exogenous progesterone significantly improves implantation and pregnancy rates after IVF. Vaginal administration offers a number of potential advantages over intramuscular injection in terms of tolerability and convenience. The clinical experience with Crinone 8%, a vaginal gel containing 90 mg micronized progesterone in a polycarbophil base, indicates that the use of this preparation is associated with pregnancy rates comparable with those achieved after intramuscular administration of progesterone. Moreover, in studies in which patient preferences have been assessed, significantly higher preferences for vaginal micronized progesterone gel have been reported, compared with intramuscular administration or vaginal suppositories. In conclusion, the vaginal micronized progesterone gel used in this study provided effective and well-tolerated luteal support in women undergoing IVF.