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Luteal phase support for assisted reproduction cycles

Overview of attention for article published in Cochrane database of systematic reviews, July 2015
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  • In the top 25% of all research outputs scored by Altmetric
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2 tweeters
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1 Wikipedia page

Citations

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79 Dimensions

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165 Mendeley
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Title
Luteal phase support for assisted reproduction cycles
Published in
Cochrane database of systematic reviews, July 2015
DOI 10.1002/14651858.cd009154.pub3
Pubmed ID
Authors

Michelle van der Linden, Karen Buckingham, Cindy Farquhar, Jan AM Kremer, Mostafa Metwally

Abstract

Progesterone prepares the endometrium for pregnancy by stimulating proliferation in response to human chorionic gonadotropin (hCG) produced by the corpus luteum. This occurs in the luteal phase of the menstrual cycle. In assisted reproduction techniques (ART), progesterone and/or hCG levels are low, so the luteal phase is supported with progesterone, hCG or gonadotropin-releasing hormone (GnRH) agonists to improve implantation and pregnancy rates. The ideal method of luteal support remains unclear. To determine the relative effectiveness and safety of methods of luteal phase support provided to subfertile women undergoing assisted reproduction. We searched databases including the Cochrane Menstrual Disorders and Subfertility Group (MDSG) Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO and trial registers. We conducted the final search in November 2014. Randomised controlled trials (RCTs) of luteal phase support using progesterone, hCG or GnRH agonist supplementation in ART cycles. Three review authors independently selected trials, extracted data and assessed risk of bias. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) for each comparison and combined data when appropriate using a fixed-effect model. Our primary outcome was live birth or ongoing pregnancy. The overall quality of the evidence was assessed using GRADE (Grades of Recommendation, Assessment, Development and Evaluation) methods. A total of 93 RCTs (25,471 women) were included. Most studies had unclear or high risk of bias in most domains. The main limitations in the evidence were poor reporting of study methods and imprecision due to small sample sizes. hCG vs placebo/no treatment (five RCTs, 746 women)No conclusive evidence was found of differences between groups in live birth or ongoing pregnancy; findings suggest benefit for the hCG group with a fixed-effect model (OR 1.76, 95% CI 1.08 to 2.86, three RCTs, 527 women, I(2) = 24%, very low-quality evidence) but not with a random-effects model (OR 1.67, 95% CI 0.90 to 3.12). hCG increased the risk of ovarian hyperstimulation syndrome (OHSS) (OR 4.28, 95% CI 1.91 to 9.6, low-quality evidence). Progesterone vs placebo/no treatment (eight RCTs, 875 women)Evidence suggests a higher rate of live birth or ongoing pregnancy in the progesterone group (OR 1.77, 95% CI 1.09 to 2.86, five RCTs, 642 women, I(2) = 35%, very low-quality evidence). OHSS was not reported. Progesterone vs hCG regimens (16 RCTs, 2162 women) hCG regimens included comparisons of progesterone versus hCG and progesterone versus progesterone + hCG. No evidence showed differences between groups in live birth or ongoing pregnancy (OR 0.95, 95% CI 0.65 to 1.38, five RCTs, 833 women, I(2) = 0%, low-quality evidence). Progesterone appeared to reduce the risk of OHSS (OR 0.5, 95% CI 0.34 to 0.76, five RCTs, 1349 women, low-quality evidence). Progesterone vs progesterone with oestrogen (16 RCTs, 2577 women)No evidence was found of differences between groups in live birth or ongoing pregnancy (OR 1.12, 95% CI 0.91 to 1.38, nine RCTs, 1651 women, I(2) = 0%, low-quality evidence) or OHSS (OR 0.56, 95% CI 0.2 to 1.63, two RCTs, 461 women, I(2) = 0%, low-quality evidence). Progesterone vs progesterone + GnRH agonist (seven RCTs, 1708 women)Live birth or ongoing pregnancy rates were lower in the progesterone-only group (OR 0.67, 95% CI 0.56 to 0.81, seven RCTs, 2113 women, I(2) = 69%, low-quality evidence). Statistical heterogeneity for this comparison was high because of unexplained variation in the size of the effect, but the direction of effect was consistent across studies. OHSS was not reported by any of the studies. Progesterone regimens (45 RCTs, 13,814 women)The included studies reported nine different comparisons between progesterone regimens. Findings for live birth or ongoing pregnancy were as follows: intramuscular (IM) versus oral: OR 0.71, 95% CI 0.14 to 3.66 (one RCT, 40 women, very low-quality evidence); IM versus vaginal/rectal: OR 1.24, 95% CI 1.03 to 1.5 (seven RCTs, 2309 women, I(2) = 71%, very low-quality evidence); vaginal/rectal versus oral: OR 1.19, 95% CI 0.83 to 1.69 (four RCTs, 857 women, I(2) = 32%, low-quality evidence); low-dose versus high-dose vaginal: OR 0.97, 95% CI 0.84 to 1.11 (five RCTs, 3720 women, I(2) = 0%, moderate-quality evidence); short versus long protocol: OR 1.04, 95% CI 0.79 to 1.36 (five RCTs, 1205 women, I(2) = 0%, low-quality evidence); micronised versus synthetic: OR 0.9, 95% CI 0.53 to 1.55 (two RCTs, 470 women, I(2) = 0%, low-quality evidence); vaginal ring versus gel: OR 1.09, 95% CI 0.88 to 1.36 (one RCT, 1271 women, low-quality evidence); subcutaneous versus vaginal gel: OR 0.92, 95% CI 0.74 to 1.14 (two RCTs, 1465 women, I(2) = 0%, low-quality evidence); and vaginal versus rectal: OR 1.28, 95% CI 0.64 to 2.54 (one RCT, 147 women, very low-quality evidence). OHSS rates were reported for only two of these comparisons: IM versus oral, and low versus high-dose vaginal. No evidence showed a difference between groups in either case. Progesterone and oestrogen regimens (two RCTs, 1195 women)The included studies compared two different oestrogen protocols. No evidence was found to suggest differences in live birth or ongoing pregnancy rates between a short and a long protocol (OR 1.08, 95% CI 0.81 to 1.43, one RCT, 910 women, low-quality evidence) or between a low dose and a high dose of oestrogen (OR 0.65, 95% CI 0.37 to 1.13, one RCT, 285 women, very low-quality evidence). Neither study reported OHSS. Progesterone appears to be the best method of providing luteal phase support, as it is associated with higher rates of live birth or ongoing pregnancy than placebo, and lower rates of OHSS than hCG. Moreover, addition of one or more doses of GnRH agonists to progesterone is associated with higher live birth and ongoing pregnancy rates than progesterone alone. Overall, addition of other substances such as oestrogen or hCG does not seem to improve outcomes, and hCG is associated with higher risk of OHSS.The route of progesterone administration does not seem to matter.

Twitter Demographics

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Mendeley readers

The data shown below were compiled from readership statistics for 165 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
India 1 <1%
Ethiopia 1 <1%
United States 1 <1%
Unknown 162 98%

Demographic breakdown

Readers by professional status Count As %
Researcher 26 16%
Student > Master 25 15%
Student > Ph. D. Student 22 13%
Unspecified 17 10%
Student > Bachelor 16 10%
Other 59 36%
Readers by discipline Count As %
Medicine and Dentistry 93 56%
Unspecified 26 16%
Agricultural and Biological Sciences 11 7%
Biochemistry, Genetics and Molecular Biology 8 5%
Nursing and Health Professions 8 5%
Other 19 12%

Attention Score in Context

This research output has an Altmetric Attention Score of 5. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 10 February 2017.
All research outputs
#3,053,300
of 12,527,219 outputs
Outputs from Cochrane database of systematic reviews
#5,467
of 8,923 outputs
Outputs of similar age
#56,650
of 231,782 outputs
Outputs of similar age from Cochrane database of systematic reviews
#165
of 250 outputs
Altmetric has tracked 12,527,219 research outputs across all sources so far. Compared to these this one has done well and is in the 75th percentile: it's in the top 25% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 8,923 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 21.2. This one is in the 46th percentile – i.e., 46% of its peers scored the same or lower than it.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 231,782 tracked outputs that were published within six weeks on either side of this one in any source. This one has done well, scoring higher than 75% of its contemporaries.
We're also able to compare this research output to 250 others from the same source and published within six weeks on either side of this one. This one is in the 33rd percentile – i.e., 33% of its contemporaries scored the same or lower than it.