June 26, 2023

expert reaction to unpublished abstract about treating couples with unexplained infertility using vaginal progesterone

A conference abstract (not a published paper) presented at the European Society for Human Reproduction and Embryology (ESHRE) looks at the use of vaginal progesterone to treat unexplained infertility.

Dr Meenakshi Choudhary, Senior Consultant in Reproductive Medicine, Newcastle Fertility Centre at Life, said:

“This study highlights the potential benefits of progesterone supplementation for couples with unexplained infertility. While the results showed promising outcomes, it’s important to consider the limitations of the small sample size. The recent publications by RCOG and ESHRE supporting progesterone use in specific cases of recurrent pregnancy loss and early pregnancy bleeding have increased its commonality in fertility and early pregnancy problems. However, the question of whether low-cost progesterone therapy should become a standard in all fertility treatments, especially when no cause is found, warrants further investigation. Larger-scale studies are needed to determine its overall effectiveness and appropriate usage in diverse fertility treatment options. Data on long term safety outcome of resultant children conceived following progesterone use during implantation and post implantation phase is also lacking and should be the focus as well with a cautious approach. Will progesterone use become a ‘hope or hype’ in women and couples with unexplained fertility problems is yet to be proven.”

Prof Richard Anderson, MRC Centre for Reproductive Health, University of Edinburgh, said:

“Many couples do not have a clear cause for why they haven’t conceived. This can be frustrating, although with time many will go on to have the babies that they want. This trial suggests that treatment with progesterone for just the 2 weeks after ovulation can improve their chances. It’s important to recognise that this is a small study and that the findings need to be confirmed, but it offers the hope that this simple and cheap treatment may help couple’s chances of successful pregnancy.”

Dr Ying Cheong, Professor of Reproductive Medicine, University of Southampton, said:

“Raperport and colleagues investigated the use of progesterone use in the second half of their menstrual cycle (luteal phase) in couples with unexplained infertility and found that live birth was higher in the treatment group, although this was statistically non-significant.

“It would be too early to confirm that progesterone should routinely be used in couples with unexplained infertility as the results did not reach statistical significance, and larger studies are now required.

“It would indeed be good news if it were shown to work as unexplained infertility can be very frustrating to manage.”

‘The PiNC Trial: Progesterone in Natural Cycles for the treatment of unexplained infertility’ by C. Raperport et al. was presented at ESHRE at 9.30am UK time on Monday 26 June 2023.

Declared interests

Prof Richard Anderson: “member of the ESHRE executive committee.”

For all other experts, no reply to our request for DOIs was received.