@misc{10481/79092,
year = {2022},
month = {12},
url = {https://hdl.handle.net/10481/79092},
abstract = {Purpose To investigate the possibility that altered actions of endogenous progesterone affect receptivity and contribute to
unexplained infertility (UI).
Methods Two authors electronically searched MEDLINE, CINAHL and Embase databases from inception to 6 July 2022
and hand-searched according to Cochrane methodology. We included all published primary research reporting outcomes
related to endogenous progesterone in natural cycles in women with UI. Studies were assessed for risk of bias using a modified
Newcastle–Ottawa Score or NHLBI Score. We pooled results where appropriate using a random-effects model. Findings
were reported as odds ratios or mean differences.
Results We included 41 studies (n = 4023). No difference was found between the mid-luteal serum progesterone levels of
women with UI compared to fertile controls (MD 0.74, − 0.31–1.79, I2 36%). Women with UI had significantly higher rates
of ‘out-of-phase’ endometrium than controls. Nine out of 10 progesterone-mediated markers of endometrial receptivity were
significantly reduced in women with UI compared to fertile controls (the remaining 1 had conflicting results). Resistance
in pelvic vessels was increased and perfusion of the endometrium and sub-endometrium reduced in UI compared to fertile
controls in all included studies. Progesterone receptor expression and progesterone uptake were also reduced in women with
unexplained infertility.
Conclusions End-organ measures of endogenous progesterone activity are reduced in women with UI compared to fertile
controls. This apparently receptor-mediated reduction in response affects endometrial receptivity and is implicated as the
cause of the infertility. Further research is required to confirm whether intervention could overcome this issue, offering a
new option for treating unexplained infertility.},
publisher = {Springer},
keywords = {Endogenous progesterone},
keywords = {Unexplained infertility},
keywords = {Endometrial biopsy},
keywords = {Steroid hormones},
keywords = {Receptivity},
title = {Endogenous progesterone in unexplained infertility: a systematic review and meta‑analysis},
doi = {10.1007/s10815-022-02689-5},
author = {Raperport, Claudia and Saeed Khan, Khalid},
}