The luteal phase after ovarian stimulation.

Area of Science:

• Reproductive endocrinology
• Assisted reproductive technology

Background:

• The luteal phase is critical for successful implantation following ovarian stimulation.
• Current evidence on luteal phase support varies depending on the stimulation protocol used.

Purpose of the Study:

• To evaluate the necessity and efficacy of luteal phase supplementation with progesterone across different ovarian stimulation protocols.

Main Methods:

• Review of existing literature and clinical practices regarding luteal phase support.
• Analysis of outcomes in cycles stimulated with clomiphene citrate/human menopausal gonadotrophins, GnRH agonists/gonadotrophins, and GnRH antagonists.

Main Results:

• Luteal supplementation with progesterone has not been proven to increase implantation rates in clomiphene citrate/human menopausal gonadotrophin cycles.
• Luteal phase support is considered essential for pregnancy achievement in GnRH agonist/gonadotrophin cycles.
• Randomized controlled trials are lacking to support luteal supplementation in GnRH antagonist cycles.
• Gonadotrophin stimulation with human chorionic gonadotrophin appears to result in an inadequate luteal phase, irrespective of agonist or antagonist use.

Conclusions:

• The requirement for luteal phase support varies significantly based on the ovarian stimulation protocol.
• Further research, particularly randomized controlled trials, is needed to clarify the role of progesterone supplementation in GnRH antagonist cycles.
• Optimizing luteal phase support remains crucial for improving pregnancy rates in assisted reproductive technology.