Zusammenfassung
Die Notwendigkeit einer Lutealphasenunterstützung nach Embryotransfer im Rahmen der
ovariellen Überstimulation und IVF gilt als gesichert. Zur Lutealphasenunterstützung
können Progesteron (P) und humanes Choriongonadotropin (hCG) allein, in Kombination,
oder in Kombinationen mit Östradiol (E2) auf verschiedenen Verabreichungswegen verwendet
werden. Die gegenständliche systematische Übersichtsarbeit widmet sich der Frage,
wie die Effizienz, im Sinne der klinischen Schwangerschaftsrate pro Embryotransfer,
der vaginalen Verabreichung von natürlichem Progesteron in Form von Kapseln, Suppositorien
und Vaginalcremes im Vergleich zu anderen Formen der Lutealphasenunterstützung, inklusive
dem Crinone® 8 % Vaginalgel, ist. Zur Beantwortung dieser Frage wurde die vorliegende
Literatur systematisch gesichtet und die relevanten Daten aus randomisierten Vergleichsstudien
zur Lutealphasenunterstützung nach IVF‐ET einer quantitativen Datensynthese unterworfen.
24 Studien mit insgesamt 5334 Patientinnen in 33 Vergleichsgruppen konnten eingeschlossen
werden. Die häufigsten Vergleichsgruppen waren: vaginales P als Kapsel/Suppositorium
vs. 1) intra-muskuläres P (Odds Ratio [OR] 0,99 [95%-Konfidenzintervall {CI} 0,58
- 1,72]); 2) hCG (1,13 [0,84 - 1,52]); 3) vaginales P + hCG (1,02 [0,76 - 1,36]);
4) Crinone® 8 % (0,96 [0,76 - 1,22]); 5) vaginales P + orales E2 (1,03 [0,68 - 1,56]);
und 6) oral verabreichtes P oder Gestagen (1,11 [0,69 - 1,76]). Die Studienergebnisse
in den einzelnen Vergleichsgruppen waren homogen, mit Ausnahme des Vergleiches von
vaginalem P vs. IM P. Die vorliegenden Literaturdaten indizieren keinen signifikanten
Unterschied der Vergleichsgruppen hinsichtlich der Wahrscheinlichkeit einer klinischen
Schwangerschaft nach IVF‐ET.
Abstract
The beneficial effect of luteal phase support after embryo transfer in IVF treatment
(IVF-ET) has unequivocally been accepted. Various substances (human chorionic gonadotropin
(hCG), progesterone (P), estradiol [E2]) and regimens of administration are employed.
The present systematic review aims at determining the efficacy of administration of
vaginal P as capsules, suppositories or vaginal cream versus other forms of luteal
phase support (including Crinone® 8 % vaginal gel) after ovarian hyperstimulation
and IVF‐ET. The available literature was reviewed and data on clinical pregnancy rates
per embryo transfer was retrieved from randomised controlled trials. 24 studies with
a total of 5334 randomized patients in 33 group comparisons were included in this
review. In these studies, various doses of vaginal P as capsules/suppositories/vaginal
cream in various administration regimens were evaluated. The following subgroups were
identified: vaginal P vs. 1) intra-muscular P (odds ratio [OR] 0.99 [95 % confidence
interval {CI} 0.58 - 1.72]); 2) hCG (1.13 [0.84 - 1.52]); 3) vaginal P + hCG (1.02
[0.76 - 1.36]); 4) Crinone® 8 % (0.96 [0.76 - 1.22]); 5) vaginal P + oral E2 (1.03
[0.68 - 1.56]); and 6) orally administered P or gestagen (1.11 [0.69 - 1.76]). Results
of individual studies were homogenous in subgroup comparisons except for vaginal P
vs. intra-muscular P. Current data from the literature indicate no significant difference
between vaginal P as capsules/suppositories/cream as compared to a wide range of other
forms of luteal phase support after IVF.
Schlüsselwörter
Progesteron - IVF - Lutealphase - Utrogest - Crinone
Key words
Progesterone - IVF - luteal phase - Crinone - Utrogest
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G. Griesinger
Klinikum für Frauenheilkunde und Geburtshilfe
Universitätsklinikum Schleswig-Holstein
Campus Lübeck
Ratzeburger Allee 160
23538 Lübeck
Email: georg.griesinger@frauenklinik.uni-luebeck.de