Luteal Phase Support in Long Agonist IVF Cycles: A Review

Abstract

Implantation failure is one of the most important limiting factors in the outcome of ART. Supraphysiological levels of steroids due to multiple corpora lutea cause negative feedback on the pituitary gland and lowers the LH levels, leading to iatrogenic luteal phase defect. Adequate luteal phase support is thus essential during In-vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) to improve implantation and pregnancy rates. The ideal method of luteal phase supplementation remains a debate. Progesterone being the key element for endometrial development and subsequent embryo implantation, is routinely used for luteal support by various routes. Recent Cochrane review comparing hCG with progesterone as luteal phase support concluded no difference between progesterone and hCG regimens in live birth or ongoing pregnancy rates. The ideas about using estradiol for luteal phase support are conflicting, some reports have favoured the addition of estradiol supplementation, while others have failed to observe any beneï¬cial effect. GnRH agonists have been found to be useful in non-down-regulated cycles as luteal support.

Keywords: Luteal phase support; Long agonist cycles; Progesterone; Estradiol; hCG; GnRH agonist; In-vitro fertilization