Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Jan 5:9:43-47.
doi: 10.4137/CMWH.S32156. eCollection 2016.

Progesterone for Luteal Phase Support in In Vitro Fertilization: Comparison of Vaginal and Rectal Pessaries to Vaginal Capsules: A Randomized Controlled Study

Mohamed Khrouf  1 , Soufiene Slimani  2 , Myriam Razgallah Khrouf  3 , Marouen Braham  2 , Maha Bouyahia  2 , Khadija Kacem Berjeb  4 , Hanene Elloumi Chaabane  5 , Ghaya Merdassi  6 , Aida Zahaf Kaffel  7 , Amel Zhioua  6 , Fethi Zhioua  8
Affiliations

Progesterone for Luteal Phase Support in In Vitro Fertilization: Comparison of Vaginal and Rectal Pessaries to Vaginal Capsules: A Randomized Controlled Study

Mohamed Khrouf et al. Clin Med Insights Womens Health. .

Abstract

Background: In IVF, Luteal phase support is usually performed using vaginal progesterone. A part of patients using this route reports being uncomfortable with this route. We tried to study whether the rectal route could be an effective alternative and associated with less discomfort.

Patients and methods: A prospective randomized controlled study. All patient were eligible for IVF treatment for infertility. After oocyte pickup, 186 patients were allocated to one the following protocols for luteal phase support: (i) rectal pessaries group: natural progesterone pessaries administered rectally 200 mg three times a day, (ii) vaginal pessaries group: natural progesterone pessaries administered vaginally 200 mg three times a day), and (iii) vaginal capsules group: natural micronized progesterone capsules administered vaginally 200 mg three times a day. On the day of pregnancy test, patients were asked to fill in a questionnaire conducted by an investigator in order to assess the tolerability and side effects of the LPS treatment taken. The primary endpoint was the occurrence of perineal irritation.

Results: Fifty eight patients were assigned to the rectal pessaries group, 68 patients to the vaginal pessaries group, and 60 patients to the vaginal capsules group. All patients adhered to their allocated treatment. Implantation and clinical pregnancy rates per transfer did not differ between the three groups. Perineal irritation, which was our primary endpoint, was the same for all the three groups (respectively 1.7 % versus 5.9 % versus 11.7%). Regarding the other side effects, more patients experienced constipation and flatulence with the rectal route, whereas more patients reported vaginal discharge in the vaginal capsules group.

Conclusion: Rectal administration for luteal phase support is effective and well accepted alternative to vaginal route.

Keywords: IVF; luteal phase support; progesterone; rectal route.

PubMed Disclaimer

Conflict of interest statement

Authors disclose no potential conflicts of interest.

Figures

Figure 1
Figure 1
Flowchart of patients included in the study. Abbreviations: COH, controlled ovarian hyperstimulation; IVF, in vitro fertilization.
See this image and copyright information in PMC

References

    1. Rosenberg SM, Luciano AA, Riddick DH. The luteal phase defect: the relative frequency of, and encouraging response to, treatment with vaginal progesterone. Fertil Steril. 1980;34(1):17–20. - PubMed
    1. Fatemi HM, Popovic-Todorovic B, Papanikolaou E, Donoso P, Devroey P. An update of luteal phase support in stimulated IVF cycles. Hum Reprod Update. 2007;13(6):581–590. - PubMed
    1. van der Linden M, Buckingham K, Farquhar C, Kremer JA, Metwally M. Luteal phase support for assisted reproduction cycles. Cochrane Database Syst Rev. 2015;7:CD009154. - PMC - PubMed
    1. Chakmakjian ZH, Zachariah NY. Bioavailability of progesterone with different modes of administration. J Reprod Med. 1987;32(6):443–448. - PubMed
    1. Ioannidis G, Sacks G, Reddy N, et al. Day 14 maternal serum progesterone levels predict pregnancy outcome in IVF/ICSI treatment cycles: a prospective study. Hum Reprod. 2005;20(3):741–746. - PubMed

LinkOut - more resources