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Korean Journal of Reproductive Medicine 2010;37(1):41-48.
Published online March 1, 2010.
Sequential use of Intramuscular and Oral Progesterone for Luteal Phase Support in in vitro Fertilization.
Sang Don Kim, Byung Chul Jee, Jung Ryeol Lee, Chang Suk Suh, Seok Hyun Kim, Shin Yong Moon
1Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Korea.
2Department of Obstetrics and Gynecology, College of Medicine, Seoul National University, Korea.
Abstract
OBJECTIVES: The aim of this study was to assess appropriate time to convert intramuscular progesterone support to oral administration for luteal phase support in in vitro fertilization (IVF). METHODS: Seventy-six cycles of IVF in which fetal heart beat was identified after treatment were included. Patients underwent controlled ovarian hyperstimulation with GnRH agonist long protocol (n=7) or GnRH antagonist protocol (n=66). Cryopreserved embryo transfer was performed in three cycles. Luteal support was initiated by daily intramuscular injection of progesterone, and after confirmation of fetal heart beat, converted to oral micronized progesterone (Utrogestan, Laboratoires Besins International, France) 300 mg daily before or after 8 gestational weeks. The oral progesterone was continued for 11 weeks. RESULTS: Overall clinical abortion rate was 3.9% (3/76) and mean time to conversion was 8(+4) gestational weeks (46+/-5.8 days after oocytes retrieval). The abortion rate was 5.6% (1/17) and 3.4% (2/59) in patients with conversion before 7 weeks and after 8 weeks, respectively, which were not statistically significant (p=0.678). The miscarriages were occurred at 9(+4) weeks, 11(+3) weeks and 11(+4) weeks. CONCLUSION: Sequential luteal support using intramuscular and oral progesterone yields a relatively low clinical abortion rate. If fetal heart beat confirmed, sequential regimen appears to be safe and convenient method to reduce patients' discomfort induced by multiple injections.
Key Words: Luteal phase support; Oral progesterone; In vitro fertilization


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