Reproductive outcomes after rescue luteal phase support for women with low serum progesterone in artificial cycles around frozen embryo transfer day: Systematic review and network meta-analysis of over 7500 patients.
Andrea Etrusco, Vittorio Agrifoglio, Antonio D'Amato et al.
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In 30 seconds
This systematic review and network meta-analysis examined rescue luteal phase support (LPS) for women with low serum progesterone around frozen embryo transfer in artificially prepared cycles. It included 12 observational studies with more than 7500 participants, comparing supplemental progesterone given by different routes. Rescue LPS was associated with reproductive outcomes approaching those in women with adequate progesterone levels. Intramuscular and vaginal administration often ranked highest, but no protocol showed clear superiority. The authors note substantial between-study heterogeneity, especially in progesterone thresholds, and call for randomized trials using standardized protocols.
Key findings
- The review included 12 observational studies comprising more than 7500 participants.
- Rescue LPS was associated with reproductive outcomes approaching those observed in women with adequate progesterone levels.
- Intramuscular and vaginal progesterone often ranked highest, but no administration protocol demonstrated clear superiority.
- Studies varied substantially, particularly in the progesterone cutoff values used to define low levels.
Why it matters
Low progesterone around transfer has been associated with reduced reproductive success, and this synthesis suggests that supplemental progesterone may help address that concern. However, the evidence does not establish which route is best, and variation in thresholds and protocols limits comparisons. The findings highlight the need for better-standardized evidence before the relative benefits of rescue approaches can be determined.
What to keep in mind
The evidence came from observational studies, with substantial heterogeneity, particularly in progesterone cutoff values; randomized trials are needed to confirm the findings.