DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20213839

Dydrogesterone usage pattern in India: a knowledge, attitude and practice survey among Indian gynaecologists

Geeta Khanna, Madhuri Dabade, Sajal Dutta, Nitin Deshpande, Girish Mane, Chetna Shah, Girish Deshmukh

Abstract


Background: There is limited data about the knowledge, perception, and routine clinical usage pattern of dydrogesterone among medical practitioners in India. Therefore, the present survey was undertaken to assess attitudes and perception/practices of obstetrician and gynaecologists towards use of dydrogesterone in the real-life setting.

Methods: Total 1168 gynaecologists across India participated in the KAP survey. Sixteen questions which explored indications, dosages, duration, efficacy, tolerability and comparison were asked and results were expressed as percentages.

Results: Dydrogesterone has been marketed since the 1960s and has been extensively used worldwide for the treatment of threatened miscarriage (TM) and recurrent miscarriage (RM). Dydrogesterone is approved for hormone replacement therapy (HRT), as well as pregnancy and non-pregnancy-related conditions where there is a progesterone deficiency. In the present survey, dydrogesterone 10 mg twice daily was found to be the most commonly preferred dosage by 823 (73%) gynaecologists. Poor tolerability, compliance and lower efficacy were reported as major limitations of micronized progesterone by 68% of doctors. The average clinical pregnancy rate noted at 12 weeks after Dydrogesterone usage was around 40% by majority of the doctors. However, 30% of doctors noted more than 40% of clinical pregnancy rate after dydrogesterone usage. Almost 35% of doctors reported that the average live birth rate noticed after dydrogesterone usage is around 40%.

Conclusions: The present KAP survey highlights that the effectiveness and the tolerability of dydrogesterone is valued by Indian gynaecologists which accounts for its robust clinical utility.


Keywords


KAP survey, Threatened miscarriage, Recurrent miscarriage, Luteal phase support, India

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References


Schindler AE. First trimester endocrinology: consequences for diagnosis and treatment of pregnancy failure. Gynecol Endocrinol. 2004;18:51-7.

Szekeres-Bartho J, Barakonyi A, Par G. Progesterone as an immunomodulatory molecule. Int Immunopharmacol. 2001;1:1037-48.

Schindler AE. Progestational effects of dydrogesterone in vitro, in vivo and on the human endometrium. Maturitas. 2009;65:S3-S11.

de Lignie `res B. Oral micronized progesterone. Clin Ther. 1999;21:41-60.

Di Renzo GC, Mattei A, Gojnic M, Gerli S. Progesterone and pregnancy. Curr Opin Obstet Gynecol. 2005;17:598-600.

Chakravarty BN, Shirazee HH, Dam P. Oral dydrogesterone versus intravaginal micronised progesterone as luteal phase support in assisted reproductive technology (ART) cycles: results of a randomised study. J Steroid Biochem Mol Biol. 2005;97:416-20.

Georg G, Christophe B, Herman T. Oral dydrogesterone for luteal phase support in fresh in vitro fertilization cycles: a new standard? Fertility and Sterility®. 2018;109:5.

Bingham JS. Single blind comparison of ketoconazole 200 mg oral tablets and clotrimazole 100 mg vaginal tablets and 1% cream in treating acute vaginal candidosis. Br J Vener Dis. 1984;60:175-7.

Arvidsson C, Hellborg M, Gemzell-Danielsson K. Preference and acceptability of oral versus vaginal administration of misoprostol in medical abortion with mifepristone. Eur J Obstet Gynecol Reprod Biol. 2005;123:87-91.

Chakravarty BN, Shirazee HH, Dam P, Goswami SK, Chatterjee R, Ghosh S. Oral dydrogesterone versus intravaginal micronised progesterone as luteal phase support in assisted reproductive technology (ART) cycles: results of a randomised study. J Steroid Biochem Mol Biol. 2005;97:416-20.

Barbosa MWP, Silva LR, Navarro PA, Ferriani RA, Nastri CP, Martins WP. Dydrogesterone vs progesterone for luteal-phase support: systematic review and meta-analysis of randomized controlled trials. Ultrasound Obstet Gynecol. 2016;48:161-70.

Manish PR, Gopeenathan P, Gopinath P.M, Das SK, Meenakshi S, Veena S. Evaluating the clinical efficacy and safety of progestogens in the management of threatened and recurrent miscarriage in early pregnancy- A review of the literature. Indian Journal of Obstetrics and Gynecology Research. 2016;3(2):157-66.

Tournaye H, Sukhikh GT, Kahler E, Griesinger G. A Phase III randomized controlled trial comparing the efficacy, safety and tolerability of oral dydrogesterone versus micronized vaginal progesterone for luteal support in in-vitro fertilization. Human Reproduction. 2017;32(5):1019-27.

Griesinger G, Blockeel G, Sukhikh GT, Patki A, Dhorepatil B, Yang DZ et al. Oral dydrogesterone versus intravaginal micronized progesterone gel for luteal phase support in IVF: a randomized clinical trial. Human Reproduction. 2018;33(12):2212-21.