Practice profile of Indian gynaecologists on the use of micronized progesterone and dydrogesterone in pregnancy and assisted reproductive technology cycles: progress survey
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20241778Keywords:
Progesterone, Micronized, Dydrogesterone, Pregnancy, InfertilityAbstract
Background: Though progesterone supplements are prescribed for progesterone deficiency in pregnant and infertile women, there is ambiguity on the different forms of progesterone supplements prescribed in various conditions, duration, dosing regimen, etc. The aim of this survey was to gain insights into the practice profile of Indian Gynaecologists on progesterone supplements and the various factors governing these choices.
Methods: A total of 513 practicing gynecologists completed a digital survey on usage patterns of Micronized progesterone (NMP) and Dydrogesterone (DYD) in pregnancy and Assisted Reproductive Technology (ART) cycles. Data were analyzed using suitable statistical tests.
Results: A total 48% and 41.9% prescribed DYD and NMP-sustained release (NMP-SR) in 20-50% patients respectively, and 58.5% prescribed NMP capsule in <20% patients. >50% gynaecologists prefer DYD as progesterone supplements for threatened abortion (TA), preterm birth (PTB), Recurrent abortion (RA), and luteal phase support (LPS) in ART. Patient’s obstetrics history (26.2%), indication (18.6%), and route of administration / efficacy (12.2% each) were the top factors considered for prescribing progesterone supplements. 67.8% gynaecologists prescribe multiple progesterone preparations and of these 38.7% combined DYD + NMP-SR. 35.8% gynaecologists prefer DYD 10 mg thrice daily to prevent preterm labour in case of twin pregnancy, and 43.5% gynaecologists reported prescribing DYD 40 mg immediately followed by 30mg/day for 7 days in TA.
Conclusions: This survey provided insights into usage patterns of oral and vaginal Progesterone preparations in PTB, TA, RA and LPS in ART. DYD emerged as a crucial component in the realm of pregnancy care.
Metrics
References
Wagh G, Kundavi S, Bachani S: Conventional and sustained-release oral natural micronised progesterone in luteal phase support, threatened miscarriage, preterm birth, and high-risk pregnancy: a review. Drugs Context. 2021;10:2021-7-1.
Cable JK, Grider MH. Physiology, Progesterone. 2023 May 1. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2024.
Huvinen E, Holopainen E, Heikinheimo O. Norethisterone and its acetate - what’s so special about them? BMJ Sex Reprod Health. 2021;47(2):102-9.
Kabiri D, Hamou Y, Gordon G, Ezra Y, Matok I. Comparing the efficacy of vaginal micronized progesterone gel and capsule for prevention of preterm birth in singleton pregnancies with short cervical length at midtrimester: an indirect comparison meta-analysis. Front Pharmacol. 2023;14:1153013.
Mario Tanguay, Barbara Cometti, Sylvie Boudreault. Comparative Bioavailability of Two Daily Subcutaneous Doses Versus a Single Dose of Intramuscular and Vaginal Progesterone Formulations in Healthy Postmenopausal Females. Clin Pharmacol Drug Dev. 2023;12(12):1221-8.
Drakopoulos P, Roelens C, De Vos M, Mackens S, Racca A, Tournaye H, Blockeel C. The Future of Luteal Phase Support in ART and the Role of Dydrogesterone. Front Reprod Health. 2021;2:618838.
Sibai B, Saade GR, Das AF, Gudeman J. Safety review of hydroxyprogesterone caproate in women with a history of spontaneous preterm birth. J Perinatol. 2021;41(4):718-25.
Drakopoulos P, Roelens C, De Vos M, Mackens S, Racca A, Tournaye H, et al. The Future of Luteal Phase Support in ART and the Role of Dydrogesterone. Front Reprod Health. 2021;2:618838.
Khanna G, Dabade M, Dutta S, Deshpande N, Mane G, Shah C, et al. Dydrogesterone Usage Pattern in India: A Knowledge, Attitude and Practice Survey among Indian Gynaecologists. Int J Reprod Contracept Obstet Gynecol. 2021;10(10):3793-8.
Lou C, Wang C, Zhao Q, Jin F. Effect of dydrogesterone and progesterone on threatened miscarriage due to corpus luteum insufficiency. Am J Transl Res. 2021;13(5):4544-52.
Updated Clinical Guidance for the Use of Progesterone Supplementation for the Prevention of Recurrent Preterm Birth. Available at: https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2023/04/updated-guidance-use-of-progesterone-supplementation-for-prevention-of-recurrent-preterm-birth?&_ga=2.119626696.1351701305.1708084840-1516255190.1708084840#maincontent. Accessed on 20 December 2023.
Jain V, McDonald SD, Mundle WR, Farine D. Guideline No. 398: Progesterone for Prevention of Spontaneous Preterm Birth. J Obstet Gynaecol Can. 2020;42(6):806-12.
Du L, Du X, Wang W, Hu L, Qiao C, Shi R. Clinical analysis on the influencing factors related to preterm twin pregnancy. Rev Assoc Med Bras (1992). 2022;68(12):1651-6.
Conde-Agudelo A, Romero R, Rehal A, Brizot ML, Serra V, Da Fonseca E, et al. Vaginal progesterone for preventing preterm birth and adverse perinatal outcomes in twin gestations: a systematic review and meta-analysis. Am J Obstet Gynecol. 2023;229(6):599-616.e3.
Dashti S, Eftekhar M. Luteal-phase support in assisted reproductive technology: An ongoing challenge. Int J Reprod Biomed. 2021;19(9):761-72.
Guideline of European Society of Human Reproduction and Embryology: Update 2019, ESHRE Reproductive Endocrinology Guideline Group. Available at: https://www.eshre.eu/-/media/sitecore-files/Guidelines/COS/ESHRE-COS-guideline_final-09102019_.pdf. Accessed on 20 December 2023.
Society for Assisted Reproduction 2022: Good clinical practice recommendations. Available at: https://www.isarindia.net/pdf/ISAR-GCPR.pdf. Accessed on 15 December 2023.
Yin H, Jiang H, Zhu J, Wang C, Cao Z, Luan K, et al. Association of serum progesterone levels on the transfer day with pregnancy outcomes in hormone replacement frozen-thawed cycles with oral dydrogesterone for strengthened luteal phase support. Taiwan J Obstet Gynecol. 2023;62(6):817-22.
Griesinger G, Blockeel C, Kahler E, Pexman-Fieth C, Olofsson JI, Driessen S, et al. Dydrogesterone as an oral alternative to vaginal progesterone for IVF luteal phase support: A systematic review and individual participant data meta-analysis. PLoS One. 2020;15(11):e0241044.
Vuong LN, Pham TD, Le KTQ, Ly TT, Le HL, Nguyen DTN, et al. Micronized progesterone plus dydrogesterone versus micronized progesterone alone for luteal phase support in frozen-thawed cycles (MIDRONE): a prospective cohort study. Hum Reprod. 2021;36(7):1821-31.
Guideline of European Society of Human Reproduction and Embryology: Update 2022, ESHRE Recurrent Pregnancy Loss Guideline Development Group. Available at: https://www.eshre.eu/Guidelines-and-Legal/Guidelines/Recurrent-pregnancy-loss. Accessed on 20 December 2023.
Elgergawy AE, Abdelnaby AE, Elbohoty SB. Routine Progesterone Supplementation in Threatened Abortion: Is it sound practice? Open Journal of Obstetrics and Gynecology. 2019;9:1541-8.
Zhao H, He W, Yang Z. A pairwise and network meta-analysis comparing the efficacy and safety of progestogens in threatened abortion. Int J Gynaecol Obstet. 2022;156(3):383-93.
Wagh GN, Kundavi Shankar KM, Bachani S. A review of conventional and sustained-release formulations of oral natural micronized progesterone in obstetric indications. Drugs Context. 2021;10:2021-7-1.
Vidal A, Dhakal C, Werth N, Weiss JM, Lehnick D, Kohl Schwartz AS. Supplementary dydrogesterone is beneficial as luteal phase support in artificial frozen-thawed embryo transfer cycles compared to micronized progesterone alone. Front Endocrinol (Lausanne). 2023;14:1128564.
Downloads
Published
How to Cite
Issue
Section
