Evaluating the benefits of progesterone supplementation during ovulation induction

This review explored the use and benefits of progesterone supplementation in women undergoing ovulation induction and intrauterine insemination.

The successful implantation of a fertilized egg into the uterus is only possible if the uterus is receptive. This requires progesterone, a hormone released during the luteal phase of the reproductive cycle. During the luteal phase, the release of gonadotropin-releasing hormone and luteinizing hormone (LH) triggers an increase in progesterone production. If levels of either hormone are disrupted, the luteal phase is shortened, and the necessary progesterone levels for supporting pregnancy are not produced.

It is thought that up to 20% of women may have luteal phase dysfunction, and progesterone supplementation has been suggested as a treatment in women undergoing ovulation induction (the use of hormonal therapy to trigger the release of an egg for fertilization). However, conflicting evidence exists regarding the benefits of progesterone supplementation. This review analyzed recent research investigating progesterone supplementation in women undergoing ovulation induction and intrauterine insemination (IUI).

This review examined five studies, including a total of 1,298 women with unexplained infertility, and covering 1,938 ovulation induction and IUI treatments. Overall, progesterone supplementation increased the likelihood of clinical pregnancy by more than 50%, and live births were twice as likely, compared to patients not receiving supplementation. Live births were close to four times as likely in the first cycle following supplementation. There was no difference in the rate of miscarriages between women receiving progesterone supplementation and those not receiving progesterone. Among women undergoing ovulation induction, progesterone increased the likelihood of clinical pregnancy by 77% in women receiving gonadotropins, however women receiving clomiphene citrate saw no benefit from progesterone supplementation.

This review concluded that progesterone supplementation can benefit women undergoing ovulation induction prior to intrauterine insemination or other artificial reproductive therapies. Greatest benefits were seen among women undergoing ovulation induction employing gonadotropins.