Progesterone luteal support after ovulation induction and intrauterine insemination: an updated systematic review and meta-analysis

Objective To evaluate the effect of progesterone (P) for luteal phase support after ovulation induction (OI) and intrauterine insemination (IUI). Design An updated systematic review and meta-analysis. Setting Not applicable. Patient(s) Patients undergoing OI-IUI for infertility. Intervention(s) Exogenous P luteal support after OI-IUI. Main Outcome Measure(s) Live birth. Result(s) Eleven trials were identified that met inclusion criteria and constituted 2,842 patients undergoing 4,065 cycles, more than doubling the sample size from the previous meta-analysis. In patients receiving gonadotropins for OI, clinical pregnancy (relative risk [RR] 1.56, 95% confidence interval [CI] 1.21–2.02) and live birth (RR 1.77, 95% CI 1.30–2.42) were more likely in P supplemented patients. These findings persisted in analysis of live birth per IUI cycle (RR 1.59, 95% CI 1.24–2.04). There were no data on live birth in clomiphene citrate or clomiphene plus gonadotropin cycles. There was no benefit on clinical pregnancy with P support for patients who underwent OI with clomiphene (RR 0.85, 95% CI 0.52–1.41) or clomiphene plus gonadotropins (RR 1.26, 95% CI 0.90–1.76). Conclusion(s) Progesterone luteal phase support is beneficial to patients undergoing ovulation induction with gonadotropins in IUI cycles. The number needed to treat is 11 patients to have one additional live birth. Progesterone support did not benefit patients undergoing ovulation induction with clomiphene citrate or clomiphene plus gonadotropins.