Role of gonadotropin-releasing hormone agonists, human chorionic gonadotropin (hCG), progesterone, and estrogen in luteal phase support after hCG triggering, and when in pregnancy hormonal support can be stopped

Luteal phase support indicated in assisted reproductive technology can be administered with the use of different progesterone preparations or alternate new options such as microdose human chorionic gonadotropin or gonadotropin-releasing hormone agonist.

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Volume 109, Issue 5, Pages 749–755

Authors:

Dominique de Ziegler, M.D., Paul Pirtea, M.D., Claus Yding Andersen, M.Sc., D.M.Sc., Jean Marc Ayoubi, M.D.

Abstract:

Luteal phase support is mandatory in ovarian stimulation cycles in assisted reproductive technology owing to a deficit in LH pulsatility after the effects of exogenous hCG—used for triggering ovulation—vanish. This is classically accomplished by means of exogenous P administration, but emerging new options include microdoses of hCG and exogenous GnRH agonist. Although luteal phase support is commonly continued for up to 10 weeks into pregnancy, there is accumulating evidence that it can be stopped after the first ultrasound or even after a positive pregnancy test.


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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

1 Comments

Go to the profile of Micah J Hill
Micah J Hill 5 months ago

Thank you for another GREAT views and reviews!  I completely agree that luteal support can rationally be stopped at the time of positive hcg in a transfer with a rescuable corpus luteum present or at the luteal-placental shift in FET cycles.  Despite this intellectual belief, I continue to provide luteal support to 10 weeks.  The risk and cost of this practice pattern is low.  This is in part because the studies supporting early termination of luteal support lack sample size to rule out non-inferiority of early stoppage at clinically meaningful levels (say 5% or less).  The second is that a significant number of pregnancies will miscarry and I don't want those patients blaming the withdrawal of luteal support as a potential cause.  Im completely willing to throw out my latter reason, if the former reason has level 1 non-inferiority data to justify that completely to patients.  I recognize there is some dissonance between what I know intellectually and what I practice on this particular issue.

In practice, when do the authors actually stop luteal support?

Keep the views and reviews coming.  These are such great reviews!!!