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The incidence of preterm birth in multiple pregnancies is as high as 60% and is even higher in pregnancies conceived after IVF &amp; ICSI. The effect of progesterone on prevention of preterm birth in twins is controversial. Our group has proven a positive effect in reduction of preterm birth, by starting progesterone from the mid-trimester, in exclusively IVF\/ICSI singleton pregnancies but not twins. The purpose of our current study was to explore the effect of earlier administration of natural progesterone, in IVF\/ICSI twin pregnancies starting at 11\u201314\u2009weeks for prevention of preterm birth.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This is a double-blind, placebo controlled, single center, randomized clinical trial. Women with dichorionic twin gestations, having an IVF\/ICSI trial were randomized to receive natural rectal progesterone (800\u2009mg daily) vs placebo, starting early from 11 to 14\u2009weeks. They also received oral and vaginal antimicrobial agents as part of our routine treatment for vaginitis and urinary tract infection. They were randomized regardless of cervical length and had no previous history of preterm birth or known Mullerian anomalies. The primary outcome was spontaneous preterm birth rate before 37\u2009weeks. The secondary outcome was; spontaneous preterm birth before 34, 32, 28\u2009weeks and neonatal outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 203 women were randomized to both groups, final analysis included 199 women as 4 were lost to follow up. The base line characteristics as well as gestational age at delivery were not significantly different between the study and the placebo group (34.7\u2009\u00b1\u20093.6 vs 34.5\u2009\u00b1\u20094.5,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.626). Progesterone administration was not associated with a significant decrease in the spontaneous preterm birth rates before 37\u2009weeks (73.5% vs 68%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.551), before 34 (20.6% vs 21.6%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.649), before 32 (8.8% vs 12.4%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.46) &amp; before 28 (4.9% vs 3.1%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.555) weeks.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Rectal natural progesterone starting from the first trimester in IVF\/ICSI twin pregnancies did not reduce spontaneous preterm birth.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>\n                      The trial was registered on 31 January 2014 at www.ISRCTN.com, number\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/doi.org\/10.1186\/ISRCTN69810120\">69810120<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12884-020-03033-4","type":"journal-article","created":{"date-parts":[[2020,6,9]],"date-time":"2020-06-09T08:03:02Z","timestamp":1591689782000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["The effect of early administration of rectal progesterone in IVF\/ICSI twin pregnancies on the preterm birth rate: a randomized trial"],"prefix":"10.1186","volume":"20","author":[{"given":"Mona Mohamed","family":"Aboulghar","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yahia","family":"El-Faissal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmed","family":"Kamel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ragaa","family":"Mansour","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gamal","family":"Serour","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4835-509X","authenticated-orcid":false,"given":"Mohamed","family":"Aboulghar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yomna","family":"Islam","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2020,6,9]]},"reference":[{"key":"3033_CR1","doi-asserted-by":"publisher","first-page":"e70549","DOI":"10.1371\/journal.pone.0070549","volume":"8","author":"JP Vogel","year":"2013","unstructured":"Vogel JP, Torloni MR, Seuc A, et al. 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