Simplifying luteal phase support in stimulated assisted reproduction cycles

Reflections

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Volume 110, Issue 6, Pages 1035–1036

Authors:

Human M. Fatemi, M.D., Ph.D.

Abstract:

Reflections on "Patient experience in a randomized trial of a weekly progesterone vaginal ring versus a daily progesterone gel for luteal support after in vitro fertilization" by Ginsburg et al.


Read the full text here.


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2 Comments

Go to the profile of Micah J Hill
Micah J Hill 11 months ago

Thank you for your wonderful reflections piece.  I have two questions.

1. Do you think that GnRH agonist use would be a bigger reason for luteal dysfunction that the high estradiol feedback?  If the GnRH receptors are down-regulated and decoupled, then LH wont function normally regardless of estradiol levels?

2. Do you think the evidence supports pulling luteal progesterone in GnRH agonist triggers once the hCG test is positive?  GnRH agonist triggers are highly luteolytic.  Do we have evidence that the corpus lutea can always be rescue by pregnancy hCG after 9-14 days of no LH/hCG stimulation following agonist trigger?

Thank you for your thoughts and expertise!

Micah

Go to the profile of Alexander Quaas
Alexander Quaas 11 months ago

This reflections piece is great "food for thought" and contains several important hypotheses that deserve further investigation.

Regarding the progesterone vaginal ring: it appears that in the US it is currently only used in a research setting. Are there other countries where it is already in widespread use? When can physicians and patients expect for it to become available in the US?