Effects of estradiol supplementation during the luteal phase of in vitro fertilization cycles: a meta-analysis

Abstract

Objective: To clarify whether adding E, to standard luteal P supplementation is beneficial both in GnRH agonist and antagonist IVF cycles. Design: Meta-analysis of nine randomized controlled trials. Setting: University hospital center for reproductive medicine and IVF. Intervention(S): None. Main Outcome Measure(s): Clinical pregnancy rate (PR) per patient, clinical PR per embryo transfer (ET), implantation rate, ongoing PR per patient, clinical abortion rate, and ectopic PR. Result(s): There were no statistically significant differences between E(2)+P versus P-only group regarding overall IVF outcomes. From seven studies including GnRH agonist cycles, no statistical significant differences were found between the two groups in clinical PR per patient (relative risk [RR] 1.32.95% confidence interval [CI] 0.79-2.19), clinical PR per ET (RR 1.83 95% CI 0.96-3.49), implantation rate (RR 1.20, 95% CI 0.34-4.21), ongoing PR per patient (RR 1.34, 95% CI 0.37-4.82), clinical abortion rate (RR 1.05 95% CI 0.48-2.28). and ectopic PR (RR 0.53 95% CI 0.07-4.10). Clinical PR per patient (RR 0.94, 95% CI 0.62-1.42) and ongoing PR per patient (RR 1.09, 95% CI 0.79-1.50) from three studies including GnRH antagonist cycles only were all similar between the two groups. Conclusion(s): The combined data presented in this meta-analysis suggest that the addition of E, to P for luteal phase support does not improve IVF outcomes in GnRH agonist and antagonist cycles. However, the authors feel that there is an obvious need for further large-scale studies regarding GnRH antagonist cycles. (Fertil Steril (R) 2010;93:428-36. (C)2010 by American Society for Reproductive Medicine.)