Duration of luteal support after IVF is important, so why is there no consistency in practice? The results of a dynamic survey of practice in the United Kingdom

Abstract

Luteal support is considered as an essential component of IVF treatment following ovarian stimulation and embryo transfer. Several studies have consistently demonstrated a benefit of luteal support compared with no treatment and whilst a number of preparations are available, no product has been demonstrated as superior. There is an emerging body of evidence which suggests that extension of luteal support beyond biochemical pregnancy does not confer a benefit in terms of successful pregnancy outcome. We performed two surveys separated by 5 years of practice evolution, with the latter reporting on the use of luteal support in all IVF clinics in the UK. All clinics reported utilising luteal support with the majority favouring the use of Cyclogest 400 mg twice daily. In contrast, there was no consensus on the optimal duration of luteal support. Whilst 24% of clinics withdrew luteal support at biochemical confirmation of pregnancy, 40% continued treatment until 12 weeks gestation. Several clinics even extended luteal support beyond 12 weeks gestation. We observed no difference in practice based on the size of the IVF unit or treatment funding source. Although there was some change in practice between surveys in many clinics, there was no uniformity in the direction of change.

A 10-Year Follow-Up on the Practice of Luteal Phase Support Using Worldwide Web-Based Surveys

“…In the 2018 survey 72% of respondents administered LPS until 8-10 gestational weeks, and the most recent 2019 survey revealed that 65% of the respondents continued LPS until 10-12 gestational weeks. Another survey conducted in the United Kingdom's ART community yielded similar results (33). These ndings represent the perception that the quality of data regarding early cessation of LPS is weak and insu cient to recommend a change in practice.…”

Early stop of progesterone supplementation after confirmation of pregnancy in IVF/ICSI fresh embryo transfer cycles of poor responders does not affect pregnancy outcome

“…The general attitude among most practitioners has been that it is better to continue progesterone than to take a risk of a pregnancy loss using the earlier stop [ 19 – 21 ]. However, assisted reproductive technology (ART) treatment for infertility couple is not an easy task.…”

“…But, some doctors discontinued progesterone supplementation at 7 weeks of pregnancy and the other doctors continued it until the 12 weeks [ 19 – 22 ]. It was thought to be better to continue progesterone than to take a risk of miscarriage using the earlier stop [ 19 – 21 ]. However, the effect of early stop of progesterone supplementation or continuation for patients with poor ovarian response (POR) has not been investigated.…”

A questionnaire-based audit to assess overall experience and convenience among patients using vaginal progesterone tablets (Lutigest^®) for luteal phase support during IVF treatment

“…In addition, local IVF protocols were followed at each participating clinic; however, this was not expected to influence patients’ assessment of ease of use and dosing convenience with the progesterone tablets. Finally, as the recommended duration for progesterone supplementation for LPS varies widely between IVF clinics (ranges from 2 to 12 weeks after oocyte retrieval), 47 patient experience with vaginal progesterone tablets for LPS beyond 14 days was not evaluated in the current audit.…”