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

OBJECTIVE

To evaluate whether the addition of E(2) for luteal phase support (LPS) in IVF/intracytoplasmic sperm injection (ICSI) could improve the outcome of clinical pregnancy.

DESIGN

Meta-analysis.

SETTING

University hospital center.

PATIENT(S): Women underwent IVF or ICSI using the GnRH agonist or GnRH antagonist protocol.

INTERVENTION(S): Progesterone alone or combined with E(2) 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 E(2) + P group and P-only group regarding the primary outcome of CPR/PA for different routes of administration of E(2) (oral, vaginal, and transdermal) or other relevant outcome measures. No significant effect was observed for different daily doses of E(2) (6, 4, and 2 mg), even through oral medication in CPR/PA.

CONCLUSION(S): The best available evidence suggests that E(2) 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.