An update of luteal phase support in stimulated IVF cycles

Author: Fatemi H.M.   Popovic-Todorovic B.   Papanikolaou E.   Donoso P.   Devroey P.  

Publisher: Oxford University Press

ISSN: 1460-2369

Source: Human Reproduction Update, Vol.13, Iss.6, 2007-09, pp. : 581-590

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Abstract

Stimulated IVF cycles are associated with luteal phase defect. In order to overcome this, different doses, durations and types of luteal phase support (LPS) have been evaluated. There is still no agreement regarding the optimal supplementation scheme. The aim of this paper is to assess the past and the current clinical practices of luteal supplementation in IVF. The databases of Medline and PubMed were searched to identify relevant publications. LPS with human chorionic gonadotrophin (hCG) [n 262, odds ratio (OR) 2.72 (95), confidence interval (CI) 1.564.90, P < 0.05]="" or="" progesterone="">n 260, OR 1.57 CI 1.13, 2.17, P < 0.05)="" results="" in="" an="" increased="" pregnancy="" rate="" compared="" with="" placebo,="" however,="" hcg="" is="" associated="" with="" increased="" risk="" of="" ovarian="" hyperstimulation="" syndrome.="" natural="" micronized="" progesterone="" is="" not="" efficient="" if="" taken="" orally.="" the="" data="" on="" oral="" dydrogesterone="" are="" still="" conflicting.="" vaginal="" and="" intra="" muscular="" progesterone="" have="" comparable="" outcomes.="" the="" addition="" of="" estradiol="">2) seems to be beneficial in long GnRH agonist protocol (implantation rate 39.6 with E2 compared with no E2; P < 0.05)="" but="" not="" in="" the="" short="" gnrh="" agonist="" and="" gnrh="" antagonist="" protocol.="" despite="" the="" early="" promising="" results,="" it="" is="" too="" early="" to="" recommend="" the="" use="" of="" gnrh="" agonist="" in="" lps.="" lps="" should="" cease="" on="" the="" day="" of="" positive="" hcg.="" since="" the="" cause="" of="" luteal="" phase="" defect="" in="" ivf="" appears="" to="" be="" related="" to="" the="" supraphysiological="" levels="" of="" steroids,="" milder="" stimulation="" protocols="" should="" be="" advocated="" in="" order="" to="" eventually="" overcome="" the="" luteal="" phase="" defect.="">