P-676 Luteal phase progesterone support in modified natural cycle frozen-thawed embryo transfer (mNC-FET): a systematic review and meta-analysis
Notice bibliographique
Résumé
Abstract Study question Does luteal phase progesterone supplementation effect the live birth rate (LBR), clinical pregnancy rate (CPR) or pregnancy loss rate (PLR) in mNC-FET? Summary answer The use of progesterone supplementation may affect CPR but does not significantly affect the LBR in mNC-FET. What is known already Fresh embryo transfer has been the standard procedure in assisted reproductive technology, but advancements in cryopreservation techniques, particularly vitrification, have established frozen-thawed embryo transfer (FET) as a viable alternative. A frequently used FET protocol is mNC-FET, in which ovulation is induced by exogenous human chorionic gonadotropin (hCG). Exogenous hCG supports the formation of a corpus luteum and the secretion of progesterone before implantation. Whether women should receive luteal phase support (LPS) in mNC-FET with endogenous progesterone production remains highly controversial. Study design, size, duration A systematic literature search was conducted in PubMed, EMBASE, and Cochrane Library using MeSH terms, Emtree terms, and text words in English related to progesterone LPS in mNC-FET up to October 2024. No limitations were applied regarding year of publication or duration of the studies. Randomized controlled trials (RCTs), retrospective and prospective cohort studies were eligible for inclusion. This systematic review incorporated data from our recently finalized large (n = 608), unpublished RCT evaluating LPS in mNC-FET. Participants/materials, setting, methods The inclusion criteria for eligible studies were women aged 18–46 undergoing mNC-FET with either progesterone as LPS, administered through various regimens, or no LPS, in both public and private hospital settings. Covidence was used for sorting and screening the studies to confirm their eligibility. Potential risk of bias was assessed using ROB2 for RCT’s and Newcastle-Ottawa Scale for retrospective cohort studies. Main results and the role of chance Out of 3,916 search results, six relevant studies were identified, and with inclusion of data from our recently finalized yet unpublished RCT, a total of seven studies were included in this review. Three of the included studies were RCTs and four were retrospective cohort studies. Overall, a total of 1680 women were included in the systematic review; 897 women received progesterone as LPS, and 783 did not. Out of the six studies, four studies, including the three RCTs, found no advantage of using progesterone LPS in mNC-FET. All four studies had low to high risk of bias. Two retrospective studies with low to moderate risk of bias found a positive effect of LPS and reproductive outcomes. The meta-analysis showed no significant difference in LBR between no LPS (n = 415) and progesterone LPS (n = 480), with a pooled OR of 1.28 (95% CI 0.96-1.70). CPR was significantly higher following progesterone LPS (n = 897) compared to no LPS (n = 783), with a pooled OR of 1.27 (95% CI 1.03-1.57). This review is the largest systematic review to date investigating the effect of progesterone LPS in mNC-FET. Limitations, reasons for caution Limitations of this review include high study heterogeneity, the retrospective design of three of the included studies carrying an inherent risk of bias and the lack of confounder adjustment in three retrospective studies. Wider implications of the findings This systematic review suggests that most women do not benefit from LPS regarding LBR in mNC-FET, implicating a need to revise current treatment protocols to avoid unnecessary use of medication as progesterone is known to cause physical discomfort, which can be avoided. Trial registration number No
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,004 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,012 | 0,002 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».