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The luteal phase after hyperstimulation for in vitro fertilization
Abstract:
Of 500 cycles in which in vitro fertilization (IVF) was undertaken, laparoscopy was performed 372 times, 272 embryo transfers were carried out, and 55 pregnancies resulted, 30 of which resulted in delivery. Of those patients who underwent laparoscopy, 156 received clomiphene citrate alone, 203 clomiphene citrate and hMG, and 13 hMG alone. All patients were found to have a luteal-phase length of 10 days or greater (measured from the time of ovulation). The midluteal urinary total estrogen (UTE) value and pregnanediol excretion (Pd2) far exceeded the levels seen in normal cycles. There were no significant differences between conceptual and nonconceptual cycles and the high levels encountered would be expected after deliberate hyperstimulation. Fifty-five patients (in whom 11 pregnancies resulted) were monitored every other day throughout the luteal phase after embryo transfer. Both conceptual and nonceptual cycles showed a peak in pregnanediol glucuronide level around luteal day 6, which then fell. The level rose again if the corpus luteum was "rescued" by the implanting embryo. While the difference was not statistically significant, the estradiol levels appeared to decrease earlier in the nonconceptual cycles than in the continuing pregnancy cycles. It is important to note that the pattern of steroid production in the follicular phase was similar in both conceptual and nonconceptual cycles. While these data are not conclusive, they suggest that some nonconceptual cycles may have suffered early corpus luteal regression. Whether luteal-phase support is indicated in patients treated with clomiphene or clomiphene/hMG therapy cannot be determined from this study. However, it is thought that a controlled study of luteal-phase support in patients so stimulated is warranted. It appears that patients treated with hMG alone tend to undergo a compressed cycle and should be given luteal-phase support since other studies have reported shortened luteal phases following such hMG therapy.