IVF and the exogenous progesterone-free luteal phase

Area of Science:

• Reproductive Endocrinology
• In Vitro Fertilization (IVF)

Background:

• Conventional IVF cycles use hCG for oocyte maturation and ovulation, followed by prolonged progesterone support.
• This regimen can be burdensome for patients and may not always be physiologically optimal.

Purpose of the Study:

• To summarize approaches for exogenous progesterone-free luteal support in IVF.
• To discuss the benefits of individualized luteal phase management.

Main Methods:

• Review of current literature on GnRH agonist triggers and progesterone-free luteal support strategies.
• Analysis of methods for corpus luteum rescue and LH activity supplementation.

Main Results:

• GnRH agonist triggering offers advantages over hCG, enabling a 'freeze all' policy for an 'OHSS-free clinic'.
• Individualized luteal phase support can create a more physiologic hormonal environment.
• Rescue of corpora lutea with LH activity is crucial for fresh embryo transfers following GnRH agonist trigger.

Conclusions:

• GnRH agonist trigger combined with 'freeze all' is optimal for preventing ovarian hyperstimulation syndrome (OHSS).
• Progesterone-free luteal support, particularly with individualized LH activity, enhances patient comfort and treatment physiology.