Luteal support
Luteal support is the administration of medication, generally progesterone, progestins, hCG or GnRH agonists, to increase the success rate of implantation and early embryogenesis, thereby complementing and/or supporting the function of the corpus luteum. It can be combined with for example in vitro fertilization and ovulation induction.
Progesterone appears to be the best method of providing luteal phase support, with a relatively higher live birth rate than placebo, and a lower risk of ovarian hyperstimulation syndrome than hCG. Addition of other substances such as estrogen or hCG does not seem to improve outcomes.
Progesterone and progestins
The live birth rate is significantly higher with progesterone for luteal support in IVF cycles with or without intracytoplasmic sperm injection. Co-treatment with GnRH agonists further improves outcomes, by a live birth rate RD of +16%.Routes and formulations
There is no evidence of any route of administration of progesterone or progestins being more beneficial than others for luteal support. The main ones are:| Dydrogesterone | 10 mg 3 times daily, or 20 mg twice daily. |
| Progesterone | 200mg, 3-4 times daily |
| Desogestrel | 450μg once per day. |
- Oral administration of progesterone or progestin pills. Oral administration of progestins provides at least similar live birth rate than vaginal progesterone capsules when used for luteal support in embryo transfer, with no evidence of increased risk of miscarriage.
- Intravaginal administration of gel, tablets or other inserts, such as endometrin. This was the most commonly used medication for luteal support in an Israeli survey in 2013, used without adjunctive medication in 77% of cases, mainly as tablets.
- Intramuscular administration. Daily intramuscular injections of progesterone-in-oil have been the standard route of administration, but are not FDA-approved for use in pregnancy.
Time of initiation
- In IVF, generally somewhere between the evening of oocyte retrieval and day 3 after oocyte retrieval, with weak evidence indicating that 2 days after oocyte retrieval may be optimal.
- In artificial insemination, luteal support is generally started on the day of insemination, or the day after.
Duration