An updated survey: the use of progesterone for luteal phase

Dear friends and colleagues,
The web-based questionnaire entitled "An updated survey on the use of progesterone for luteal phase support in stimulated IVF cycles" was posted on the IVF-Worldwide website on May 24and was open for data entry until and June 26, 2012.

The aim of this survey was to study the current clinical practice for luteal phase support in stimulated ART cycles.
It is undisputed that progesterone is needed to support the luteal phase. However, at present there are several progesterone preparations available: vaginal, IM, and oral.
408 units, from 82 countries representing a total of 284,600 treated IVF cycles/year, answered the questionnaire. The results were analyzed and reviewed as presented below.
The analysis was based on the number of IVF cycles reported by the unit and not on the number of units in the study. For each question, the survey provided multiple choices from which only a single answer could be chosen ("radio buttons").
Between May 24 and June 26, 2012, 481 IVF units from 82 countries responded to the survey. Of the 481 units, 408 units passed the computerized system's quality assurance test.

Table 1: Total number of cycles by continents:

Overall, the average number of treatment cycles per participating center was approximately 700 cycles/year. 42 IVF- centers reported between 1000 and 2000 cycles, 14 IVF- centers reported between 2001 and 4000 cycles, and only eight IVF-centers treated more than 4000 cycles per year. In total, this report analyzed 284,600 treated IVF cycles.

Question:
If you support the luteal phase, when do you start the regimen you are using?

In most of the treated cycles Progesterone was started on the day of egg collection. 15% support the luteal phase from the time of embryo transfer.

Question:
Which agent/route is your treatment of choice to support the luteal phase

In almost two-thirds (77%) of cycles reported, vaginal progesterone alone is used for luteal phase support (LPS), In another 17% of cycles, combination of vaginal progesterone with IM progesterone or oral progesterone is being used. As a single agent, IM progesterone is used in 5% of cycles. Human chorionic gonadotropin, as a single agent for LPS is not being used at all.

Question:
If you use vaginal progesterone, which formulation do you use?

The most commonly used vaginal progesterone is vaginal tablets which is used in 45% of cycles. Vaginal gel is used in 25% of cycles and suppositories 14%. A combination of vaginal preparations is used in 14% of cycles.

Question
How long so you continue progesterone sepplementation of the patient concieved?

In 15% of cases where the patient conceives, progesterone is administered until pregnancy is confirmed. In 13% progesterone is administered until fetal heartbeat. In 44% of cases progesterone is administered until 8-10 weeks of gestation and in 28% it is given up to 12 weeks or more.

A comparison between the previous survey on progesterone support performed 2 years ago, and the current survey

The web-based questionnaire entitled ‘Progesterone support in IVF’ was posted on the IVF-Worldwide website on 20 August 2009 and was open for data entry until 5 September 2009.
Eighty-four IVF treatment centers from 35 countries, representing a total of 51,155 IVF cycles per year, completed the survey.
There is a major change in clinical use of agents or luteal support. hCG is now out of use. The use of IM progesterone declined significantly. There is an increase in the use of vaginal progesterone, and if the patients conceived the use of progesterone is now being shortened.

The shift in the clinical practice of progesterone is approaching the E.B.M. published in the field