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An updated survey on the use of progesterone for luteal phase support in stimulated IVF cycles

Dear friends and colleagues,
Two years ago, we initiated the first survey among worldwide IVF units on luteal phase supplementation in stimulated IVF cycles. The results received gave us all some perspective on the way we translate evidence-based medicine into clinical practice. This first survey covered respondents from 84 IVF centers in 35 countries, representing 51,155 cycles per year.
Findings showed that vaginal progesterone alone was used for luteal phase supplementation in 64% of cycles. In another 16% of cycles, vaginal progesterone was used in combination with either intramuscular (15%) or oral progesterone (1%). As a single agent, intramuscular progesterone was used in 13% of cycles, oral progesterone in another 2%, and hCG was still used in 5% of cycles. Progesterone was administered until 10–12 weeks of gestation in 67% of cycles; in 22% of cycles, it was discontinued when fetal heart pulsations were detected, and in 12%, it was administered until the patient received a positive pregnancy test.
As this survey was performed 2 years ago, we wish to know if worldwide clinical practices have changed since then. Please assist us by completing the survey below. Your responses will benefit the international IVF community.
As survey administrators, we thank you for your support of this initiative.
The survey is conducted by Dr. Ariel Weissman, Wolfson Institute, Israel, Milton Leong, Hong Kong Sanatorium and Hospital, Zeev Shoham, Kaplan Medical center, Israel, Edi Vaisbuch, Kaplan Medical center, Israel

If you support the luteal phase, when do you start the regimen you are using?
  • On the day of hCG administration.
  • On the day of egg collection.
  • On the day of embryo transfer.
  • A few days after embryo transfer.
  • I do not support the luteal phase.

 

Which agent/route is your treatment of choice to support the luteal phase?
  • hCG.
  • Vaginal progesterone.
  • IM progesterone.
  • Oral progesterone.
  • Combination of the drugs mentioned above.
  • Other.

 

If you use vaginal progesterone, which formulation do you use?
  • Vaginal progesterone in gel (such as Crinone).
  • Vaginal suppositories (such as Endometrin).
  • Vaginal tablets (such as Utrogestan).
  • Combination of the above.
  • I do not use vaginal progesterone.

 

If you use oral progesterone, which drug do you prefer?
  • Micronized progesterone (such as Utrogestan).
  • Hydroxyprogesterone caproate/medroxyprogesterone acetate.
  • Dydrogesterone (Duphaston).
  • I do not use oral progesterone.

 

How long do you continue progesterone supplementation if the patient conceives?
  • Until pregnancy is confirmed in a blood or urine test (week 4) or 14 days after embryo transfer.
  • Until the presence of a fetal heartbeat.
  • Until gestational week 8–10.
  • Until gestational week 12 or later.
  • I do not administer progesterone.

 

Since there are no clear recommendations for oral progesterone dosing, and the dose of vaginal progesterone is recommended by the manufacturer, what dose of oral progesterone do you use with micronized progesterone (such as Utrogestan)?
  • 200 mg/d
  • 400 mg/d
  • 600 mg/d
  • 800 mg/d
  • I do not use oral progesterone.

 

Since there are no clear recommendations for oral progesterone dosing, and the dose of vaginal progesterone is recommended by the manufacturer, what dose of oral progesterone do you use with dydrogesterone (Duphaston)?
  • 10 mg/d
  • 20 mg/d
  • 30 mg/d
  • 40 mg/d
  • I do not use oral progesterone.