Luteal support in reproduction: when, what and how?

Area of Science:

• Reproductive Endocrinology
• In Vitro Fertilization (IVF)

Background:

• Luteal phase support (LPS) is crucial in IVF cycles utilizing gonadotropin-releasing hormone analogues.
• Optimal protocols for LPS, including hormone type, dosage, and timing, remain a subject of global debate.

Purpose of the Study:

• To review current and original data on luteal phase support protocols in IVF.
• To address controversies regarding hormone selection, dosage, duration, and timing of LPS initiation and cessation.

Main Methods:

• Comprehensive review of original and recent literature on luteal phase support in IVF.
• Analysis of data concerning hormone efficacy, administration routes, and timing.

Main Results:

• Progesterone is the consensus choice for LPS, favored over human chorionic gonadotropin due to lower risk of ovarian hyperstimulation syndrome.
• While intramuscular progesterone may offer superior pregnancy rates, vaginal administration is more common due to fewer side effects.
• LPS initiation timing (hCG day, oocyte retrieval, or embryo transfer) does not impact pregnancy rates.
• Strong evidence supports stopping LPS on the day of the pregnancy test or the first ultrasound (6-7 weeks gestation).
• Adding estrogen to LPS protocols has not demonstrated improved pregnancy rates.

Conclusions:

• Progesterone is the recommended agent for luteal phase support in IVF.
• LPS should commence within two days of ovulation triggering.
• Discontinuation of LPS is advised on the day of the beta-hCG test or the first ultrasound scan (6-7 weeks of pregnancy).