Treatment of Luteal Phase Defects in Assisted Reproduction

Abstract

Abnormal luteal function is a common issue in assisted reproduction techniques associated with ovarian stimulation probably due to low levels of LH in the middle and in the late luteal phase. This defect seems to be associated with supraphysiological steroid levels at the end of follicular phase. The luteal phase insufficiency has not got a diagnostic test which has proven reliable in a clinical setting. Luteal phase after ovarian stimulation becomes shorter and insufficient, resulting in lower pregnancy rates. Luteal phase support with progesterone or hCG improves pregnancy outcomes and no differences are found among different routes of administration. However, hCG increases the risk of ovarian hyperstimulation syndrome. In relation to the length of luteal support, the day of starting it remains controversial and it does not seem necessary to continue once a pregnancy has been established. After GnRHa triggering ovulation, intensive luteal support or hCG bolus can overcome the defect in luteal phase, but more studies are needed to show the LH utility as support.

The relationship between estradiol-progesterone alterations after ovulation trigger and treatment success in intrauterine insemination cycles

“…These data partially explain why we experienced lower rates of pregnancy in women with high estradiol drop after ovulation trigger; an average estrogenic effect is necessary for optimal corpus luteum function. The proposed underlying mechanisms of insufficient function of the corpus luteum included “supraphysiologic estradiol level, decreased luteinizing hormone level, inhibition of the corpus luteum, and asynchronization of estradiol and progesterone” ( 30 , 31 ) . A Meta-analyses on estrogen plus progesterone replacement during luteal phase of the cycle showed higher rates of clinical pregnancy compared with progesterone alone in women undergoing IVF ( 32 ) .…”

Role of Ultrasound in the Assessment of Female Infertility

“…After ovulation induction, supporting the luteal phase with proges terone or hCG has shown to improve pregnancy outcomes. 25 Some authors found vaginal progesterone to be the most effica cious with the least side effects while hCG was asso ciated with the risk of ovarian hyperstimulation. 26 In some instances, the LPD associated with controlled ovarian hyper stimulation (COH) for IVF was not correctable.…”

Effects of estradiol injection on outcome of in-vitro fertilization: a randomized, double-blind, placebo controlled trial

“…Although the luteal phase hormonal support for alleviating the assisted reproduction techniques is proved, there is however controversy regarding the agents to be used for luteal phase support in stimulated cycles [8][9][10]. Previous reports have clearly shown that supplementation of prog-esterone and human chorionic gonadotropin (hCG) increase the implantation and pregnancy rates [11][12][13][14].…”