Luteal phase support

Abstract

Objective: To develop a consensus regarding the need for luteal phase support during assisted reproductive technology (ART), and to establish the optimal compound and route of administration for this purpose.

Design: Review of the published literature on luteal phase support.

Patient(s): Women undergoing assisted reproductive technologies.

Intervention(s): Progesterone was administered orally, vaginally, or by intramuscular (i.m.) injection to supplement the luteal phase after assisted reproductive technology (ART).

Main outcome measure(s): Pregnancy following ART. RESULT(S); Gonadotropin releasing hormone (GnRH)-agonist protocols necessitate the use of luteal phase support. Progesterone and human chorionic gonadotrophin (hCG) have both been used for this purpose, with comparable outcomes. Progesterone is the product of choice, however, as it is associated with a lower incidence of ovarian hyperstimulation syndrome (OHSS). Its use is indicated up to the serum pregnancy test. Oral, i.m., and vaginal progesterone preparations are available. Intramuscular and vaginal preparations lead to comparable rates of implantation and clinical pregnancy, despite higher serum progesterone levels after i.m. injection. Oral formulations are inferior products for luteal support. Although widely used, i.m. progesterone is uncomfortable and inconvenient for patients. By contrast, the vaginal progesterone gel (Crinone 8%) is more convenient and easier to use.

Conclusion(s): Progesterone support of the luteal phase in in vitro fertilization (IVF) cycles is indicated, though support beyond the serum pregnancy test may not be needed. The pregnancy rates after vaginal and i.m. progesterone support are comparable, despite higher serum levels after i.m. injection. Patients prefer the vaginal progesterone gel.