Editorial Commentary: Is it time to abandon progesterone supplementation of early pregnancy after IVF?
Abstract
Editorial Commentary: Is it time to abandon progesterone supplementation of early pregnancy after IVF? Georg Griesinger * Department of Obstetrics and Gynecology , University of Lübeck, Lübeck , Germany * ↵ Correspondence address. Tel: + 49-451-500-2206 ; Fax: +49-451-500-5764; E-mail: griesing@uni-luebeck.de Received January 7, 2011. Revision received January 7, 2011. Accepted January 10, 2011. It is estimated that a million couples receive IVF treatment globally every year ( ICMART, 2009 ). The majority of women who become pregnant after IVF receive progesterone during the first trimester. A study conducted by Kyrou et al. published in the present issue of Human Reproduction challenges this concept for GnRH-antagonist treatment cycles and thereby adds to the growing concern that progesterone supplementation of early pregnancy after IVF might overall be unnecessary. The scientific evidence on which progesterone supplementation of early pregnancy was introduced to the field is unfortunately weak and stems from only a single randomized study ( Prietl et al ., 1992 ) on 120 subjects. IVF patients who received a combination of intra-muscular estrogen and progesterone supplementation until 12 weeks of pregnancy had an ongoing pregnancy rate of 89% compared with only 59% in the group with no supplementation. Although these data may not pass rigorous re-assessment, they have formed the basis for a treatment standard, namely continuation of progesterone administration in early pregnancy after IVF. Accordingly, Crinone ® , a vaginal progesterone formulation licensed for luteal phase support by the European Medicine Agency (EMEA), has on its label to continue administration ‘for 30 days if there is laboratory evidence of pregnancy’. The US Food and Drug Administration (FDA) label for the same product reads: ‘If pregnancy occurs, treatment may be continued until placental autonomy is achieved, up to 10–12 … (Full Text of this Article)