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Related Concept Videos

Ovarian Cycle01:27

Ovarian Cycle

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The menstrual cycle includes a critical component known as the ovarian cycle, which undergoes two main phases each month—the follicular phase and the luteal phase. The follicular phase is variable and averaging around 14 days. Ovulation, triggered by a surge in luteinizing hormone (LH), marks the transition between the two phases. The second phase, the luteal phase, is relatively consistent, lasting approximately 14 days, and is marked by the activity of the corpus luteum. While a cycle...
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Hormonal Regulation of the Menstrual Cycle01:22

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The ovarian cycle regulates endometrial changes throughout a single menstrual cycle via the coordinated action of gonadotrophin-releasing hormone (GnRH) and gonadotrophins.
At puberty, GnRH begins a pulsatile release pattern, which triggers the anterior pituitary gland to secrete follicle-stimulating hormone (FSH) and luteinizing hormone (LH). The frequency and amplitude of GnRH pulses vary across the menstrual cycle, with faster pulses favoring LH release and slower pulses favoring FSH...
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Hormonal Control of the Ovarian Cycle01:30

Hormonal Control of the Ovarian Cycle

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The ovarian cycle is meticulously regulated by the hypothalamic-pituitary-gonadal axis. This cycle orchestrates the release of a mature oocyte, essential for reproduction.
Before puberty, the hypothalamus releases GnRH in a low frequency, low amplitude pulsatile manner. This along with the immature hypothalamic-pituitary-gonadal axis activity, results in low estrogen levels and the absence of a fully functional ovarian cycle.  At puberty, GnRH secretion increases in both frequency and...
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Proliferative Phase01:20

Proliferative Phase

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The proliferative phase typically occurs after menstruation and lasts between 6 to 13 days in a standard 28-day cycle. This phase involves the reconstruction of the endometrium, guided by estrogen produced by the developing ovarian follicle.
Notably, the stratum basale, the basal layer of the endometrium, including the basal parts of the uterine glands, remains unaffected by menstruation. Stem cells in this layer undergo mitosis, regenerating the stratum functionalis and thickening the...
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Secretory Phase01:19

Secretory Phase

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The secretory phase of the menstrual cycle, spanning from day 14 to 28 in a typical 28-day cycle, is a period of significant physiological changes in the female reproductive system. This phase commences immediately after ovulation and is characterized by the preparation of the endometrium for potential embryo implantation.
Following ovulation, the corpus luteum, a temporary endocrine structure, produces progesterone and estrogens. These hormones stimulate the growth and coiling of endometrial...
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The Menstrual Cycle01:19

The Menstrual Cycle

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The menstrual cycle is a recurrent sequence of changes in the uterine endometrium, specifically its functional layer, the stratum functionalis. This cycle prepares the uterus for potential pregnancy. This cycle typically spans 21–35 days, averaging 28 days, and aligns with the ovarian cycle, regulated by fluctuating levels of ovarian hormones, primarily estrogen and progesterone.
The menstrual phase occurs from days 1 to 5 and involves the shedding of the stratum functionalis, as a...
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The Luteal Phase after GnRHa Trigger-Understanding An Enigma.

Kathrine Leth-Moller1, Sandra Hammer Jagd1, Peter Humaidan2

  • 1Faculty of Medical Science, University of Southern Denmark, Odense, Denmark.

International Journal of Fertility & Sterility
|November 8, 2014
PubMed
Summary

Luteal phase support is crucial in IVF/ICSI cycles. Modified luteal phase support protocols following GnRH agonist triggering can improve pregnancy outcomes, matching those seen with hCG triggering.

Keywords:
GnRHaHCGIVFLuteal Phase

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Area of Science:

  • Reproductive Endocrinology
  • In Vitro Fertilization

Background:

  • Stimulated IVF/ICSI cycles disrupt the luteal phase due to supraphysiological steroid concentrations from multifollicular development.
  • This disruption inhibits luteinizing hormone (LH) secretion, causing a luteal phase defect.
  • Gonadotropin-releasing hormone (GnRH) antagonist protocols allow GnRH agonist (GnRHa) triggering for oocyte maturation, reducing ovarian hyperstimulation syndrome (OHSS).

Purpose of the Study:

  • To review luteal phase differences between natural cycles, hCG triggering, and GnRHa triggering.
  • To present recent data on optimizing luteal phase support after GnRHa triggering.

Main Methods:

  • Review of existing literature and randomized controlled trials.
  • Comparison of luteal phase characteristics and outcomes across different triggering methods.
  • Analysis of modified luteal phase support strategies.

Main Results:

  • GnRHa triggering, while reducing OHSS risk, was previously associated with poor clinical outcomes and early pregnancy losses despite standard luteal phase support.
  • Modifications to luteal phase support protocols have shown promising results, leading to comparable reproductive outcomes to hCG triggering.
  • Optimized luteal phase support is key to successful outcomes with GnRHa triggering.

Conclusions:

  • The luteal phase defect following GnRHa triggering can be overcome with modified luteal phase support.
  • Optimized luteal phase support protocols are essential for achieving successful pregnancy rates comparable to hCG triggering.
  • Further research into tailored luteal phase support strategies is warranted for GnRHa-triggered IVF/ICSI cycles.