Estrogen Supplementation to Progesterone as Luteal Phase Support in Patients Undergoing in Vitro Fertilization

Background: Infertility is a complex medical condition affecting a significant portion of the population. Intracytoplasmic sperm injection (ICSI) has become an established technique for addressing infertility. Objective: To evaluate the role of oral oestradiol (E2) supplementation (4mg) with progesterone in the luteal phase versus progesterone alone in the outcome of patients undergoing ICSI cycles (intracytoplasmic sperm injection). Methods: In this study, 160 patients undergoing intracytoplasmic sperm injection (ICSI) at a reproductive medicine centre in Alexandria were randomly assigned to two groups. Group A (n=80) received progesterone I.M. injections (100mg daily) and vaginal pessaries of micronized progesterone 400mg for 14 days from oocyte retrieval, continuing until 10 weeks in case of occurrence of pregnancy. Group B (n=80) received the same progesterone regimen as Group A, with additional oral estradiol valerate (4mg) from oocyte retrieval for 14 days, continuing estrogen until fetal pulsation appeared by ultrasound, and progesterone until 10 weeks in case of pregnancy. Results: There was a significant difference in the number of embryos transferred, it did not influence pregnancy outcomes. Additionally, endometrial thickness was comparable between the two groups. Pregnancy outcomes have insignificant differences between the two groups. Conclusions: To overcome the luteal phase defect in IVF cycles with the use of GnRH antagonist LPS is needed. Progesterone was approved as luteal phase support in IVF/ICSI cycles but the effect of additional estradiol to progesterone, as luteal phase support, on the pregnancy rate in women undergoing IVF/ICSI is debatable.