Human Reproduction Update Advance Access originally published online on July 11, 2007
Human Reproduction Update 2007 13(6):581-590; doi:10.1093/humupd/dmm021
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An update of luteal phase support in stimulated IVF cycles
1 Centre for Reproductive Medicine (VUB/CRG), Dutch-Speaking Free University Brussels, Laarbeeklaan 101, 1090 Brussels, Belgium 2 Clinica Alemana of Santiago, Vitacura 5951, Santiago, Chile
3 Correspondence address. Tel: +32 2 477 6699; Fax: +32 2 477 6333; E-mail: hmousavi{at}uzbrussel.be
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) 1.56–4.90, 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 (E2) 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.
Key words: luteal phase support / IVF / progesterone
Received on February 23, 2007; revised May 15, 2007; accepted on June 1, 2007
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