LUTEAL PHASE SUPPORT An evidence-based approach. M. Aboulghar Cairo – Egypt IZMIR 2008. Normal luteal function is essential for maintaining pregnancy several studies have shown that removal of the corpus luteum during early pregnancy results in complete abortion (Csapo et al. 1974).
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Cairo – Egypt
Normal luteal function is essential for maintaining pregnancy several studies have shown that removal of the corpus luteum during early pregnancy results in complete abortion (Csapo et al. 1974)
The agonists, either by themselves, or in connection with supraphysiological hormone profiles, may create an iatrogenic luteal phase defect (Macklon and Fauser, 2000)
Luteal-phase deficiency is a common problem in current ARTs and has been described in cycles using pituitary down-regulation with a GnRH agonist as well as in those using GnRH antagonists(Macklon & Fauser, 2000; Kolibianakis et al., 2003)
Luteal phase support was considered essential to counter any luteal insufficiency that may have a negative impact on an early pregnancy (Smitz et al, 1992, 1993)
Over the years, it became clear that luteal phase support had a positive effect on outcome. A 1994 meta-analysis of randomized trials indicated that the use of hCG or progesterone led to significantly higher pregnancy rates that placebo (Soliman et al. 1994)
Progesterone has become the agent of choice for luteal supplementation, because hCG is associated with a higher risk of OHSS (MacDougall et al 1992).
In a prospective randomized study, it was found that delaying introduction or progesterone supplementation to day 6 after oocyte retrieval resulted in reduced pregnancy rate (Shaun et al 2001).
A prospective randomized trial did reveal a significant difference in implantation rates between women who received i.m. progesterone and those who received an oral micronized progesterone preparation (Licciardi et al 1999).
In a prospective randomized study of high responders, oral progesterone, chlormadinon acetate showed a comparable pregnancy rate and live birth rate with im progesterone (Iwase et al 2008).
Cicinelli et al. (2000) found that serum progesterone levels were higher after i.m. administration than after vaginal gel administration, although endometrial progesterone levels were significantly higher after vaginal progesterone gel.
In a Cochrane review 2004, conclusion were luteal phase support with hCG or progesterone after ART results in an increased pregnancy rate, hCG does not provide better results progesterone and it has higher risk of OHSS. The optimal route of progesterone administration has not yet been established.(Daya and Gumby 2004)
In a review by Penzias (2000), the author’s conclusion was that progesterone support is indicated though support beyond the day of BhCG may not be needed, vaginal and im progesterone are equal in outcome despite higher serum progesterone in im injections, patients prefer vaginal route.
In a randomized study, investigators compared a vaginal progesterone gel (Crinone 8%), 90 mg once daily, with an oral progesteron preparation (Utrogestan, 400 mg once daily, and i.m. progesterone in oil, 50 mg once daily. The clinical and ongoing pregnancy rates were comparable between the vaginal gel and i.m. groups, but significantly (P<.05) lower with the oral formulation (Saucedo et al 2000)
Addition of estradiol to progesterone for luteal supplementation in patients stimulated with GnRH antagonist/rFSH for IVF: a randomized controlled trial (Fatemi et al 2006)
Luteal phase GnRH administration enhances ICSI clinical outcome after protocols by agonist and antagonist, possibly by a combination of effects on the embryo and corpus luteum (Tesarik et al. 2006)
- Clinical associates: