P-54: The Effect of Luteal Phase Support onPregnancy Rate of Stimulated IUI Cycles in UnexplaiendInfertility

Background: Progesterone (P) that is produced by the corpus luteum in response to stimulation by luteinizing hormone (LH) and human Chrionic Gondotropin (hCG) in luteal phase is essential for secretory transformation of endometrium that permits implantation .P not only supports endometrial development but also potentially sustains the survival of the embryo . Luteal phase dysfunction (LPD) is associated with inadequate P production and consequent implantation failure. P supplementation is the most commonly used treatment when LPD can reasonably be assumed.Controlled ovarian hyper stimulation (COH) combined with intrauterine insemination IUI or invitro fertilization (IVF) are commonly used treatment protocols for couples with unexplained infertility UEI .. LPD and lack of P may also occur as part of assisted reproductive techniques ,including aspiration of granulosa cells or the use of gonadotropin releasing hormone (GnRh) analogs ; therefore luteal phase support(LPS) with P is a common practice in IVF cycles.The existence of LPD in stimulated IUI cycles is controversial subject.In COH cycles, multifollicular development and supraphysiologic steroid serum concentration may adversely affect LH secretion via a long-loop mechanism. Disturbed LH secretion may induce LPD with premature luteolysis, reduced luteal phase LH concentration, low P level andshortened luteal phase . The previous studies have produced conflicting results and amount of data from wellcontrolled clinical trials is limited and further studies are required to characterize the impact of treatment with P for LPS in stimulated IUI cycles. The main aim of this study was to evaluate the effect of vaginal P (Cyclogest, 400mg progesterone, vaginal pessaries, Cox Pharmaceuticals, Barn staple, UK) on pregnancy and live birth rates in stimulated IUI cycles in UEI. Materials and Methods: Single-center, prospective, randomized and blinded controlled trial in a tertiary care University fertility center, In 200 couples with UEI undergoing 511 consecutive stimulated IUI cycles, Clomiphene citrate and human Menopausal Gonadotropin (h M G) were used for ovulation induction. After IUI, the patients were randomized into the study group (n=98) received intra vaginal P (Cyclogest) for LPS. The patients randomized into the control group (n=102) received no LPS. Our outcome measures were Clinical Pregnancy rate (PR) and live birth rate (BR) per cycle and patient. Data were analyzed by Student, t and Chisquare tests. Results: were no differences in demographic characteristics between the groups. Clinical Pregnancy rate per patient and cycle were similar in the study group (30.6% and 11.5%, respectively), and in the control group (25.5% and 10.03%, respectively) . There were no statistically significant increase in live birth rate per patient and cycle between the study group (19.4 % and 7.5 %, respectively) and the control group (14.7 and 5.7% , respectively). Conclusion: Administration of vaginal P (Cyclogest) for LPS does not improve the reproductive outcome of stimulated IUI cycles.