Egyptian Foundation of Reproductive Medicine and Embryology Survey for Luteal Support in IVF among Fertility Specialists

Document Type : Debate

Authors

1 Obstetrics and Gynecology, Department, Faculty of Medicine, Alexandria University, Egypt.

2 Egyptian Foundation of Reproductive Medicine and Embryology (EFRE), Egypt.

3 Biomedical Informatics & Medical Statistics, Medical Research Institute, Alexandria University, Egypt.

Abstract

Background: The currently used protocols for luteal phase support during IVF are variable among centers. In certain areas, the practice is neither evidence based nor guidelines driven. Objective: to evaluate practitioners’ preferences and extent of deviation from current evidence. Methods: A survey was designed using Google Forms. Invitations were sent via 1341 emails and 110 WhatsApp links. Results: 120 responded to questionnaires (8.27%). In fresh cycles, 81.5% of participants did not individualize LPS protocol based on evidence alone; they rather considered patient preferences. The dose of vaginal progesterone used is (≥ 600 mg). 78% of national participants use combination of vaginal route with IM either daily or every 3 days, however, the international participants prefer to use IM/3 days. In frozen cycles, 75% of national and international participants did not use vaginal progesterone alone. The most deviant from guidelines was that 32.7% of Egyptian participants use estrogen for luteal support in antagonist cycles. In Fresh cycles, 60% of Egyptian participants continued LPS beyond 8 weeks while no one of the international participants does. Whereas in frozen cycles, 50% of international experts used a different policy of continuing LPS beyond 8 weeks. Conclusion: Individualization of LPS protocol needs more consideration as apparently, the practice is not individualized and not adherent to guidelines in the progesterone dose, formulation and when to stop LPS. The practice of vaginal progesterone alone is declining. Unjustifiable high doses and long duration of progesterone are used. The empiric use of estradiol and oral progestin should be audited.

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