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Meta-Analysis
. 2018 Jun 1;22(2):148-156.
doi: 10.5935/1518-0557.20180018.

Oral dydrogesterone vs. vaginal progesterone capsules for luteal-phase support in women undergoing embryo transfer: a systematic review and meta-analysis

Marina Wanderley Paes Barbosa  1   2 , Natália Paes Barbosa Valadares  1 , Antônio César Paes Barbosa  1 , Adelino Silva Amaral  1 , José Rubens Iglesias  1 , Carolina Oliveira Nastri  2 , Wellington de Paula Martins  3 , Hitomi Miura Nakagawa  1
Affiliations
Meta-Analysis

Oral dydrogesterone vs. vaginal progesterone capsules for luteal-phase support in women undergoing embryo transfer: a systematic review and meta-analysis

Marina Wanderley Paes Barbosa et al. JBRA Assist Reprod. .

Abstract

Objective: To identify, appraise, and summarize the evidence from randomized controlled trials (RCTs) comparing oral dydrogesterone to vaginal progesterone capsules for luteal-phase support (LPS) in women offered fresh or frozen embryo transfers following in vitro fertilization.

Methods: Two independent authors screened the literature for papers based on titles and abstracts, then selected the studies, extracted data, and assessed the risk of bias. Dydrogesterone and progesterone were compared based on risk ratios (RR) and the precision of the estimates was assessed through the 95% confidence interval (CI).

Results: An electronic search performed on June 7, 2017 retrieved 376 records, nine of which were papers deemed eligible and included in this systematic review and quantitative analysis. Good quality evidence indicates that oral dydrogesterone provided at least similar results than vaginal progesterone capsules on live birth/ongoing pregnancy (RR=1.08, 95%CI=0.92-1.26, I2=29%, 8 RCTs, 3,386 women) and clinical pregnancy rates (RR 1.10, 95% CI 0.95 to 1.27; I2=43%; 9 RCTs; 4,061 women). Additionally, moderate quality evidence suggests there is no relevant difference on miscarriage rates (RR=0.92, 95%CI=0.68-1.26, I2=6%, 8 RCTs, 988 clinical pregnancies; the quality of the evidence was downgraded because of imprecision).

Conclusions: Good quality evidence from RCTs suggest that oral dydrogesterone provides at least similar reproductive outcomes than vaginal progesterone capsules when used for LPS in women undergoing embryo transfers. Dydrogesterone is a reasonable option and the choice of either of the medications should be based on cost and side effects.

Keywords: IVF; dydrogesterone; luteal phase support; meta-analysis.

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Conflict of interest statement

CONFLICT OF INTEREST

The authors have no conflict of interest to declare.

Figures

Figure 1
Figure 1
Flowchart of study selection.
Figure 2
Figure 2
Forest plot for live birth/ongoing pregnancy. Risk of bias legend: A = Selection bias (random sequence generation); B = Selection bias (allocation concealment); C = Performance bias; D = Detection bias; E = Attrition bias; F = Reporting bias; G = Other biases.
Figure 4
Figure 4
Forest plot for miscarriage. Risk of bias legend: A = Selection bias (random sequence generation); B = Selection bias (allocation concealment); C = Performance bias; D = Detection bias; E = Attrition bias; F = Reporting bias; G = Other biases.
Figure 3
Figure 3
Forest plot for clinical pregnancy. Risk of bias legend: A = f4 Selection bias (random sequence generation); B = Selection bias (allocation concealment); C = Performance bias; D = Detection bias; E = Attrition bias; F = Reporting bias; G = Other biases.
Figure 5
Figure 5
Funnel plot analysis for clinical pregnancy.
See this image and copyright information in PMC

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