Luteal phase support for assisted reproduction cycles

Abstract

BackgroundProgesterone prepares the endometrium for pregnancy by stimulating proliferation in response to human chorionic gonadotropin (hCG), which is produced by the corpus luteum. This occurs in the luteal phase of the menstrual cycle. In assisted reproduction techniques (ART) the progesterone or hCG levels, or both, are low and the natural process is insufficient, so the luteal phase is supported with either progesterone, hCG or gonadotropin releasing hormone (GnRH) agonists. Luteal phase support improves implantation rate and thus pregnancy rates but the ideal method is still unclear. This is an update of a Cochrane Review published in 2004 (Daya 2004). ObjectivesTo determine the relative effectiveness and safety of methods of luteal phase support in subfertile women undergoing assisted reproductive technology. Search methodsWe searched the Cochrane Menstrual Disorders and Subfertility Group (MDSG) Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, CINAHL, Database of Abstracts of Reviews of Effects (DARE), LILACS, conference abstracts on the ISI Web of Knowledge, OpenSigle for grey literature from Europe, and ongoing clinical trials registered online. The final search was in February 2011. Selection criteriaRandomised controlled trials of luteal phase support in ART investigating progesterone, hCG or GnRH agonist supplementation in in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI) cycles. Quasi-randomised trials and trials using frozen transfers or donor oocyte cycles were excluded. Data collection and analysisWe extracted data per women and three review authors independently assessed risk of bias. We contacted the original authors when data were missing or the risk of bias was unclear. We entered all data in six different comparisons. We calculated the Peto odds ratio (Peto OR) for each comparison.

How low is too low? Cycle day 28 estradiol levels and pregnancy outcomes

“…However, several retrospective studies failed to show any significant impact of either mid-luteal E 2 level or a luteal phase E 2 drop on pregnancy rates after IVF (9). Furthermore, the routine use of luteal phase E 2 supplementation after IVF has not been associated with any improvement in cycle outcomes across a variety of studies (10,11).…”

Administration d’agonistes de la GnRH (Gonadotrophin Releasing Hormone) en phase lutéale des protocoles substitutifs de transferts d’embryons congelés : étude prospective randomisée

“…Depuis, plusieurs é tudes ont é té ré alisé es, retrouvant des ré sultats discordants. Trois mé ta-analyses [5][6][7] confirment cependant l'augmentation des taux de grossesses et de naissances. Jusqu'à pré sent, aucune é tude n'a é té ré alisé e dans le cadre des TEC.…”

“…Plus ré cemment, l'ajout d'un agoniste de la gonadotropin releasing hormone (GnRH) à ce soutien est é voqué pour amé liorer l'implantation. Trois mé ta-analyses [5][6][7] confirment l'augmentation des taux de grossesses et de naissances. Le mé canisme d'action reste incertain.…”

Use of Hormone Replacement in Females with Endocrine Disorders

“…Rings containing natural progesterone are used for contraception in breastfeeding women [5]. Vaginal gel (8% of progesterone) is used for infertility treatments [6]. Progestins are synthetic molecules.…”