P-768 A network meta-analysis yields new insights on the efficacy of different progestogen regimens for luteal support in fresh embryo in vitro fertilization

Abstract Study question How do seven progestogen regimens rank in their efficacy for achieving clinical pregnancy when used as luteal support women undergoing fresh embryo transfer? Summary answer Given and based on rate, intramuscular progesterone was most effective, followed by oral dydrogesterone then micronized vaginal gel. What is known already A large number of randomized controlled trials (RCTs) have compared vitro fertilisation cycle with progestogens. systematic reviews conventional meta-analyses likewise been published. network meta-analysis integrates direct indirect comparisons between treatments a single analysis, allows the ranking estimation heterogeneity both effect any given treatment inconsistency (‘incoherence') evidence from different pairs treatments. Network can thus increase precision robustness inferences literature estimates. design, size, duration search performed using BIOSIS, Embase, MEDLINE supplemented manual searches to identify RCTs reporting during transfer. compare regimens, combining across selected studies R package ‘netmeta’ fixed random effects models. The analysis repeated confirmed SAS. Participants/materials, setting, methods Peer-reviewed full publications that individual progestogens (either placebo or another progestogen) were included. Studies excluded if they included frozen transfers, human chorionic gonadotropin formulations not currently available indication, did report at least rate. Two authors (EK, QW) individually reviewed papers collect data. Where doses differed an noted results combined. Main role chance Among 1987–2022, 35 met inclusion criteria, comprising 17,955 observations 7 plus resulting 43 pairwise rate (the primary outcome). Based model, top three versus (IM) progesterone, Duphaston® (oral dydrogesterone), Crinone® (micronized gel) (see Figure). Compared placebo, only 3 compounds had confidence intervals zero, risk difference (95% interval) 0.08 (0.01-0.14) IM 0.07 (0.01-0.13) Crinone®. P-score (fixed, random) was: 0.77, 0.79; 0.78, 0.69; 0.65, 0.65; Cyclogest® (vaginal progesterone) 0.58, 0.60; Endometrin® 0.52, 0.54; Prolutex® (subcutaneous 0.31, 0.36; Utrogestan® 0.34, 0.31; 0.05, 0.06. Ranking SUCRA score (surface under cumulative curve). thoroughly ensure similarity assumption. Homogeneity consistency investigated fulfilled. Exclusion placebo-controlled impact overall rankings. Limitations, reasons caution Treatment assumed identical arms each study therefore this analysis. Most single-centre small sample size. Methodological rigor heterogenous trials. Direct compounds. Wider implications findings Three showed positive placebo. Frequently preparations lead league table comparative collated. Relevant differences likely exist regimens. Trial registration n/a