Does progesterone supplementation improve pregnancy rates in clomiphene citrate and intrauterine insemination treatment cycles?

摘要

Aim: To investigate the effect of empiric use of luteal phase progesterone supplementation to improve endometrial receptivity in women undergoing treatment with clomiphene citrate incombination with intrauterine insemination (CC-IUI).Design: Retrospective cohort analysis.Setting: University fertility center. Patients: 426 CC-IUI cycles from 292 patients with unexplained infertility.Interventions: Patients were treated with micronized intravaginal progesterone 100mg twice daily beginning approximately three days after CC-IUI.Main outcome measure(s): Clinical pregnancy per initiated cycle as defined by presence of fetal heart rate on ultrasound.Results: Clinical pregnancy rate was higher in patients receiving luteal phase support comparedto patients not receiving luteal phase support (odds ratio: 2.04; 95% confidence interval: 1.01-4.14) after adjusting for all factors in the analysis using a multivariate logistic regression model.Age at the start of the cycle, BMI and CC dose were not shown to have an effect on clinicalpregnancy rates. Patients with endometrial lining (EML) thickness 6-8 mm and >8mm hadincreased clinical pregnancy rates compared to EML <6mm independent of luteal phaseprogesterone use. Patients who appear to receive the greatest benefit of progesteronesupplementation are in the 6-8 mm EML cohort.Conclusions: Luteal phase progesterone supplementation in CC-IUI cycles can improveendometrial receptivity as judged by the improved clinical pregnancy rates as the primaryoutcome.