Effects of giving progesterone and progesterone + estrogen on pregnancy rates for luteal phase support, in IVF-ICSI-ET cycles

Objective: The aim of this study is to compare the pregnancy rate achieved in IVF/ICSI-ET cycles with gonadotropin releasing hormone analogues (GnRHa) and supported with only progesterone or progesterone plus estrogen during the luteal phase.Materail and Methods: While hypophyser suppression will continue after the cessation of GnRHa which is used in the controlled ovarian hyperstimulation cycles, the levels of estrogen and progesterone are decreasing in the middle of luteal phase. This study evaluates whether adding estrogen to the routine progesterone use for luteal phase support, ameliorates pregnancy rates. The study was conducted in the assisted reproduction unit of the department of obstetrics & gynecology in the University of Cukurova School of Medicine between December 2008 and October 2009. Data from the 142 infertile women aged from 20 to 40 years old were prospectively collected. Half of them received 90 mg progesterone gel via transvaginal route and the others had additionally transdermal estrogen patch given weekly. The levels of estrogen are determined on the day of transfer of embryo and 12th day. Both groups are compares for the estrogen levels, ß-hCG positivity, continuing pregnancy, biochemical abortion and clinical abortion rates.Results: The number of women who had positive ß-hCG was 20 (28.2%) in the group with progesterone + estrogen and 18 (25.4%) in the group progesterone alone. Continuing pregnancy rate was 11 (15.5%) in the group progesterone + estrogen and 10 (14.4%) in the group progesterone alone. Biochemical and clinical abortion rates were 7 (9.9%) and 6 (8.5%); 1 (1.4%) and 1(1.4%) consecutively in the group of progesterone + estrogen and progesterone alone.Conclusion: Our study showed that adding supplementary estrogen to the progesterone has no positive effect on the estrogen levels, ß-hCG positivity, continuing pregnancy, biochemical abortion and clinical abortion rates. Furthermore we did not detect any significant difference on the estrogen levels at the transfer day or 12th day. However the 12th day estrogen level was significantly elevated in pregnants. We concluded that the adding estrogen has no sense, but increased estrogen levels at the 12th day may be clue of ovarian hyperstimulation.Keywords:IVF-ICSI-ET Cycles, GnRH analogues, luteal support, progesterone, estrogen.