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• W1988558225 abstract "We read with interest Dr. Penzias’ recent review article (1Penzias A.S. Luteal phase support.Fertil Steril. 2002; 77: 318-323Abstract Full Text Full Text PDF PubMed Scopus (118) Google Scholar) on luteal phase support with Progesterone (P). Although we agree that most patients undergoing IVF-ET prefer vaginal P supplementation to IM P and that P supplementation beyond a positive pregnancy test may not be indicated, we disagree with his conclusion that the pregnancy rates after these two types of support are comparable. In support of his conclusion, Dr. Penzias cites two conflicting, published, nonrandomized trials that compared pregnancy and implantation rates in IVF-ET patients who were supplemented with Crinone and historic controls who were supplemented with IM P. In addition, he reviews his program’s extensive nonrandomized experience with Crinone, vaginal P suppositories and IM P, presented at the ESHRE 2000 annual meeting, as well as several smaller nonrandomized studies comparing Crinone and IM P presented at the ASRM 2000 annual meeting. Dr. Penzias called for randomized, controlled trials to confirm the findings of the observational and nonrandomized cohort studies, but did not review the randomized P supplementation studies that have been performed to date. We also presented the results of our randomized, controlled P supplementation trial at the ASRM 2000 annual meeting, recently published in this journal (2Propst A.M. Hill J.A. Ginsburg E.S. Hurwitz S. Pollitch J. Yanushpolsky E.H. A randomized study comparing Crinone 8% and intramuscular progesterone supplementation in in vitro fertilization-embryo transfer cycles.Fertil Steril. 2001; 76: 1144-1149Abstract Full Text Full Text PDF PubMed Scopus (85) Google Scholar). Two hundred two women were randomized to receive once daily supplementation with either 90 mg of Crinone or 50 mg of IM P beginning the day after oocyte retrieval. Women randomized to luteal phase and early pregnancy supplementation with IM P had significantly higher implantation (24% vs. 18%), clinical pregnancy (48% vs. 30%), and live birth (39% vs. 25%) rates than women supplemented with Crinone. There have been two published, randomized, controlled trials comparing vaginal P suppositories and IM P luteal phase supplementation in women undergoing IVF-ET. Smitz et al. reported similar live birth (19% vs. 31%) and implantation (12% vs. 16%) rates in 262 women supplementation with either P vaginal suppositories (600 mg/day) or IM P (50 mg/day) (3Smitz J. Devroey P. Faguer B. Bourgain C. Camus M. Van Steirteghem A.C. A prospective randomized comparison of intramuscular or intravaginal natural progesterone as a luteal phase and early pregnancy supplement.Hum Reprod. 1992; 7: 168-175Crossref PubMed Scopus (108) Google Scholar). Both groups also received luteal phase estrogen supplementation. In addition, Perino et al. randomized 300 women to supplementation with either IM P (50 mg/day) or micronized vaginal P suppositories (200 mg/day) and reported significantly higher clinical (46% vs. 27%) and term pregnancy (44% vs. 22%) rates in the IM P group (4Perino M. Brigandi F.G. Abate F.G. Costabile L. Balzano E. Abate A. Intramuscular versus vaginal progesterone in assisted reproduction a comparative study.Clin Exper Obstet Gynecol. 1997; 24: 228-231PubMed Google Scholar). Vaginal P is clearly more patient friendly than IM P. Several nonrandomized studies have reported excellent implantation and pregnancy rates with both Crinone and micronized P capsules. However, the randomized, controlled trials to date do not support that IM P and vaginal P are equivalent. Until more large, randomized studies are published, we believe IM P should remain the gold standard for P supplementation for IVF-ET. The difference that makes a difference?Fertility and SterilityVol. 78Issue 4Preview Full-Text PDF Reply of the authorFertility and SterilityVol. 78Issue 4Preview Full-Text PDF" @default.
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• W1988558225 date "2002-10-01" @default.
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• W1988558225 title "The difference that makes a difference?" @default.
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