Skip to main content Accessibility help
×
Hostname: page-component-7479d7b7d-jwnkl Total loading time: 0 Render date: 2024-07-13T15:44:28.105Z Has data issue: false hasContentIssue false

17B - Luteal Phase Support Should Be Stopped at the Time of a Positive Pregnancy Test

Against

from Section III - The Best Policy

Published online by Cambridge University Press:  25 November 2021

Roy Homburg
Affiliation:
Homerton University Hospital, London
Adam H. Balen
Affiliation:
Leeds Centre for Reproductive Medicine
Robert F. Casper
Affiliation:
Mount Sinai Hospital, Toronto
Get access

Summary

The pivotal role of luteal phase support (LPS) in establishing and maintaining IVF pregnancies has been one of the earliest subjects to become evidence-based in clinical ART. Following controlled ovarian stimulation (COS) and ovulation triggering by hCG, pulsatile pituitary LH secretion has been demonstrated to be severely compromised and unable to support normal function of the corpora lutea, resulting in a deficient luteal phase that must be pharmaceutically supported. This was initially demonstrated for GnRH agonist protocols and subsequently confirmed for GnRH antagonist cycles as well. After implantation, embryonic hCG takes over pituitary LH in supporting the corpus luteum (CL) and maintains its function until the establishment of the luteo-placental shift, at around the 8th gestational week. It has been clearly demonstrated that LPS is crucial in filling the gap between the disappearance of exogenously administered hCG for ovulation triggering and the initiation of secretion of endogenous hCG from the implanting conceptus. Early studies have estimated that exogenously administered hCG remains in the circulation for up to 7 days, and that the CL has a remarkable ability to recover after a week of deprivation from gonadotropin stimulation (1).

Type
Chapter
Information
Publisher: Cambridge University Press
Print publication year: 2021

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Weissman, A, Loumaye, E, Shoham, Z. Recovery of corpus luteum function after prolonged deprivation from gonadotrophin stimulation. Hum Reprod. 1996;11:943–9.CrossRefGoogle ScholarPubMed
Vaisbuch, E, de Ziegler, D, Leong, M, Weissman, A, Shoham, Z. Luteal-phase support in assisted reproduction treatment: real-life practices reported worldwide by an updated website-based survey. Reprod Biomed. 2014;28:330–5.CrossRefGoogle ScholarPubMed
Watters, M, Noble, M, Child, T, Nelson, S. Short versus extended progesterone supplementation for luteal phase support in fresh IVF cycles: a systematic review and meta-analysis. Reproduct Biomed. 2019.CrossRefGoogle Scholar
Griesinger, G. Editorial commentary: is it time to abandon progesterone supplementation of early pregnancy after IVF? Hum Reprod. 2011;26:1017–19.CrossRefGoogle ScholarPubMed
Neumann, K, Depenbusch, M, Schultze-Mosgau, A, Griesinger, G. Characterization of early pregnancy placental progesterone production by utilization of dydrogesterone in programmed frozen-thawed embryo transfer cycles. Reprod Biomed. 2020.CrossRefGoogle Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×