Meta-analysis of estradiol for luteal phase support in in vitro fertilization/intracytoplasmic sperm injection

Objective To evaluate whether the addition of E 2 for luteal phase support (LPS) in IVF/intracytoplasmic sperm injection (ICSI) could improve the outcome of clinical pregnancy. Design Meta-analysis. Setting University hospital center. Patient(s) Women underwent IVF or ICSI using the GnRH agonist or GnRH antagonist protocol. Intervention(s) Progesterone alone or combined with E 2 for LPS. Main Outcome Measure(s) Clinical pregnancy rate per patient (CPR/PA), clinical pregnancy rate per ET, implantation rate, ongoing pregnancy rate per patient, clinical abortion rate, and ectopic pregnancy rate. Result(s) Fifteen relevant randomized controlled trials (RCTs) were identified that included a total of 2,406 patients. There was no statistical difference between E 2 + P group and P-only group regarding the primary outcome of CPR/PA for different routes of administration of E 2 (oral, vaginal, and transdermal) or other relevant outcome measures. No significant effect was observed for different daily doses of E 2 (6, 4, and 2 mg), even through oral medication in CPR/PA. Conclusion(s) The best available evidence suggests that E 2 addition during the luteal phase does not improve IVF/ICSI outcomes through oral medication, even with different daily doses. Furthermore, RCTs that study other administration routes are needed.