Luteal-phase support in assisted reproductive technology: An ongoing challenge

Area of Science:

• Reproductive Endocrinology
• In Vitro Fertilization
• Assisted Reproductive Technology

Background:

• Defective luteal phases frequently occur during controlled ovarian hyperstimulation cycles.
• Optimizing luteal-phase support (LPS) is crucial for improving pregnancy rates in assisted reproductive technology (ART).
• Current protocols for LPS in in vitro fertilization (IVF) cycles, especially those using gonadotropin-releasing hormone agonist (GnRH-a) triggering, remain a subject of debate.

Purpose of the Study:

• To review and summarize various luteal-phase support protocols.
• To discuss strategies for enhancing pregnancy outcomes in fresh and frozen embryo transfer cycles.
• To address the ongoing controversy regarding the optimal composition and timing of LPS initiation in IVF.

Main Methods:

• Literature review of existing studies and clinical guidelines on luteal-phase support in IVF.
• Analysis of different pharmacological interventions used for LPS, including progesterone, human chorionic gonadotropin (hCG), estradiol, GnRH-a, and recombinant luteinizing hormone (rLH).
• Examination of protocols specifically for GnRH-a triggered cycles.

Main Results:

• Various agents like progesterone, hCG, estradiol, and rLH are employed for LPS.
• GnRH-a triggering presents unique challenges for effective luteal-phase support.
• Evidence suggests differing efficacy and optimal timing for LPS components across various IVF protocols.

Conclusions:

• Luteal-phase support is essential for successful IVF outcomes.
• Further research is needed to establish standardized and optimal LPS protocols, particularly in GnRH-a triggered cycles.
• Personalized approaches to LPS may be necessary to address individual patient needs and improve live birth rates.