The role of steroid hormone supplementation in non–assisted reproductive technology treatments for unexplained infertility

Abstract

Fertility treatment strategies are evolving, with a more rapid transition to assisted reproductive technology (ART) treatments after unsuccessful non-ART treatments. This trend increases the potential importance of adjuvant treatments in non-ART cycles, such as steroid hormone supplementation. It has been established that success rates of ART treatments are increased with the use of luteal support with progesterone. In the setting of non-ART cycles, however, the evidence is less clear, and clinical practices vary widely between providers and clinics. In this review, we aimed to provide an overview of the current evidence for the use of steroid hormone supplementation, including progesterone for luteal support, estrogens, androgens, and mineralocorticoids, in the setting of non-ART treatments for ovulatory women.

Progesterone luteal support after ovulation induction and intrauterine insemination: an updated systematic review and meta-analysis

“…As a result, there are insufficient data to form conclusions regarding the utility of luteal phase P support in these cycles. Limitations of these data have recently been reviewed by Quass and Hansen (42). The current data are clinically heterogeneous, lack placebo control, lack double-blind design, and arise from single-center study designs.…”

Liquid chromatography–mass spectrometry applications for quantification of endogenous sex hormones

“…Progesterone is a sex hormone derived from cholesterol and is an essential precursor for glucocorticoids and mineralocorticoids. Progesterone levels are often actively monitored in patients seeking fertility assistance, as its role in ovulation is well characterized (Ciampaglia & Cognigni, 2015; Quaas & Hansen, 2016). Furthermore, this hormone plays a role in pregnancy maintenance, and exogenous progesterone may be administered during early pregnancy to counteract deficiencies (Coomarasamy et al, 2015; Quaas & Hansen, 2016; Ransom & Murtha, 2012).…”

“…Progesterone levels are often actively monitored in patients seeking fertility assistance, as its role in ovulation is well characterized (Ciampaglia & Cognigni, 2015; Quaas & Hansen, 2016). Furthermore, this hormone plays a role in pregnancy maintenance, and exogenous progesterone may be administered during early pregnancy to counteract deficiencies (Coomarasamy et al, 2015; Quaas & Hansen, 2016; Ransom & Murtha, 2012). Additionally, evidence to support the role of progesterone in cognition and its neuroprotective effect in traumatic brain injury in animals has recently surfaced (Henderson, 2018; Stein & Wright, 2010).…”

Maternal age at delivery and fertility of the next generation

“…Infertility, defined as the absence of pregnancy despite 12 months of regular unprotected sexual intercourse, affects 9‐18% of the population with an unexplained cause in 10‐30% of cases . While most known causes of infertility relate to the health of the woman and/or her partner, recently questions have been raised regarding the possible contributions of transgenerational or epigenetic factors …”