The use of vaginal natural progesterone for prevention of preterm birth in IVF/ICSI pregnancies.

Abstract The aim of this study was to evaluate the effect of vaginal natural progesterone on the prevention of preterm birth in IVF/intracytoplasmic sperm injection (ICSI) pregnancies. A single-centre prospective placebo-controlled randomized study was performed. A total of 313 IVF/ICSI pregnant patients were randomized into two groups for either treatment with daily 400mg vaginal natural progesterone or placebo, starting from mid-trimester up to 37weeks or delivery. Amongst the patients, there were 215 singleton and 91 twin pregnancies. There was no significant difference in risk of preterm birth among all patients (OR 0.672, 95% CI 0.42–1.0. There was a significantly lower preterm birth rate in singleton pregnancies in the natural progesterone arm (OR 0.53, 95% CI 0.28–0.97) and no significant difference between both arms in twin pregnancies (OR 0.735, 95% CI 0.36–2). In conclusion, the administration of 400mg vaginal natural progesterone from mid trimester reduced the incidence of preterm birth in singleton, but not in twin, IVF/ICSI pregnancies. Preterm labour is a major cause of perinatal and neonatal mortality and morbidity. It is defined as birth occurring prior to 37weeks' gestation; however, most damage occurs in infants born before 34weeks. It was reported that pregnancies achieved by IVF or intracytoplasmic sperm injection (ICSI) are more liable to preterm labour. The objective of this study was to evaluate the effect of progesterone (given to the patient vaginally) on the prevention of preterm labour in IVF/ICSI pregnancies. Patients who became pregnant after IVF or ICSI were randomized into two groups. The first group was given 400mg of vaginal progesterone starting from mid trimester until 37weeks of pregnancy, and the second group received no treatment. The results showed that administration of 400mg vaginal progesterone from mid trimester reduces the incidence of preterm labour in singleton, but not in twin, IVF/ICSI pregnancies.