The role of luteal support during IVF: a qualitative systematic review

Abstract

The aim of this review is to provide qualitative evidence-based synthesis regarding efficacy of luteal-phase support on fertility outcome in women undergoing in vitro fertilization (IVF) with respect to clinical or live birth rates and pregnancy loss rates. Although the need of luteal phase support in IVF/ICSI cycles is well-known, the optimal start, dosage, route and the duration of the luteal phase support is still subject of debate. Data suggest that the optimal period to start with the luteal phase support would be between 24–72 hours after oocyte-retrieval and should continue at least until a positive pregnancy test is achieved. However, the majority of IVF-centers worldwide provide progesterone support up to 8 weeks of pregnancy. Among the well-established routes of luteal support, oral dydrogesterone and subcutaneous progesterone represent new and interesting routes of progesterone administration. The current studies support these routes of progesterone administration use in terms of comparable pregnancy rates and pregnancy loss rates to vaginal and intramuscular progesterone. Furthermore, the acceptance and tolerability among patients seems to be even better. In the frozen-thawed embryo transfer, dydrogesterone and vaginal progesterone are not effective as monotherapy treatments; however, when combined there is no reason to avoid one or the other in this setting.

摘要

本综述的目的是在临床出生率或活产率和妊娠丢失率方面, 就黄体支持对体外受精（IVF）妇女生育结局的有效性提供基于证据的定性综合分析。虽然IVF/ICSI周期中黄体支持的必要性是众所周知的, 但黄体支持的最佳起始、剂量、途径和持续时间仍存在争议。数据表明, 黄体支持的最佳起始时间为卵母细胞取出后24-72小时, 并应至少持续到妊娠试验呈阳性。然而, 世界上大多数的IVF中心提供孕酮支持直至妊娠第8周。在已知的黄体支持途径中, 口服地屈孕酮和皮下孕酮制剂是一种新的并且感兴趣的孕酮给药途径。目前的研究支持这些途径的孕酮管理应用与阴道内和肌肉内孕酮应用, 在妊娠率和流产率的比较。此外患者的接受度和耐受性似乎更好。在冷冻胚胎移植中, 地屈孕酮和阴道孕酮作为单药治疗效果不佳；然而在联合应用时, 无理由避免一种或另一种设定组合。

The Chinese abstracts are translated by Prof. Dr. Xiangyan Ruan and her team: Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China.

Keywords:

• Progesterone
• IVF/ICSI cycles
• ovarian stimulation
• luteal phase support
• infertility

Disclosure of interest

The authors report no conflict of interest.

Acknowledgement

The authors are grateful to Gabrielle Kalke Hinterbuchner for professional language editing of the manuscript.