Analysis of the bleeding pattern in assisted reproduction cycles with luteal phase supplementation using vaginal micronized progesterone

This study was designed to determine the effects of a vaginal micronized pr ogesterone preparation on bleeding patterns and pregnancy outcomes after in -vitro fertilization and intracytoplasmic sperm injection (IVF-ICSI), The s tudy population consisted of 149 consecutive women who had undergone IVF-IC SI using 'long-protocol' stimulation with buserelin-human menopausal gonado trophin (HMG), A retrospective chart analysis of computerized medical recor ds was undertaken. Vaginal progesterone (200 mg three times daily) was begu n the day before oocyte retrieval and continued for a minimum of 16-19 days following human chorionic gonadotrophin (HCG) administration. Occurrence o f bleeding following HCG injection, pregnancy rate and outcomes, and serum concentrations of oestradiol were measured. Women undergoing IVF and embryo transfer with ICSI and using vaginal progesterone for luteal support had n ormal luteal phase lengths (day of HCG minus day of onset of bleeding). In the absence of pregnancy, bleeding occurred after 19.2 +/- 3.9 days (mean /- SD), Out of the pregnant group only three women bled within 19 days of H CG administration: two had biochemical pregnancies which spontaneously vani shed and one evolved to term. The results reflect the normal bleeding patte rn to be expected when vaginal progesterone is used for luteal support in I VF and embryo transfer, an approach whose efficacy has been amply proven. N o shortened luteal phases were observed using vaginally administered proges terone.