The efficacy of luteal phase support in women with polycystic ovary syndrome following assisted reproductive technology: a systematic review

Abstract

Polycystic ovary syndrome (PCOS) is a complex endocrine condition prevalent among a significant number of women during their reproductive years. Remarkably, 90–95% of women seeking infertility solutions due to anovulation are diagnosed with PCOS. Luteal phase support (LPS) is a crucial aspect of assisted reproductive technologies (ART). This systematic review aimed to evaluate the effectiveness of LPS in women with PCOS undergoing ART, with a focus on pregnancy rates as the primary endpoint. A systematic search was conducted on EMBASE, PubMed, and Scopus databases without language restrictions. We searched for studies up to August 1, 2023. The search strategy used terms related to PCOS and LPS. Clinical trials and cohort studies involving infertile women with PCOS undergoing ART were included. The Risk of Bias 2 (ROB2) and the Newcastle-Ottawa Scale (NOS) tool were used to assess the risk of bias. The review included five studies comprising a total of 818 patients. The studies used various ovulation induction medications, such as letrozole, clomiphene citrate, and human menopausal gonadotropin, in combination with different forms of progesterone for LPS (oral, intramuscular, and intravaginal). The overall results demonstrated inconsistent efficacy of LPS, with some studies showing significant improvements in pregnancy rates with LPS, while others showed no statistically significant difference. The systematic review suggests that LPS may improve pregnancy rates in women with PCOS undergoing ART. However, the effectiveness appears to be influenced by the choice of ovulation induction agent and the route of progesterone administration. Personalized treatment approaches considering patient response and emerging evidence are essential.