Luteal Phase Support Using Subcutaneous Progesterone: A Systematic Review

Abstract

Luteal phase support (LPS) is crucial in assisted reproductive technology (ART)cycles when the luteal phase has been found to be defective. Such deficiencyis most likely related to the supraphysiological steroid levels that usually occurr instimulated cycles which, in turn, could severely affect luteinizing hormone (LH) secretionand function, thereby negatively influencing the luteal phase. A number of differentmedications and routes have been successfully used for LPS in ART. Although anoptimal protocol has not yet been identified, the existing plethora of medicationsoffer the opportunity to personalize LPS according to individual needs. Subcutaneousadministration progesterone has been proposed for LPS and could represent analternative to a vaginal and intramuscular route. The aim of the present systematicreview is to summarize the evidence found in the literature concerning the applicationof subcutaneous progesterone in ARTs, highlighting the benefits and limits of this novelstrategy.With this aiminmind, we carried out systematic research in theMedline, ISIWebof Knowledge, and Embase databases from their inception through to November 2020.Randomized controlled trials (RCTs) were preferred by the authors in the elaborationof this article, although case-control and cohort studies have also been considered.According to our findings, evidence exists which supports that, in women with a goodprognosis undergoing a fresh in vitro fertilization (IVF) cycle, subcutaneous Pg is notinferior to vaginal products. In the Frozen-thawed embryo transfer (FET) cycle, dataconcerning efficacy is mixed with an increased miscarriage rate in women undergoinga subcutaneous route in oocyte donor recipients. Data concerning the acceptance ofthe subcutaneous route versus the vaginal route are encouraging despite the differentscales and questionnaires which were used. In addition, a cost-effective analysis has notyet been conducted.