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Treatment with progesterone has been found to improve pregnancy rates in menstruating women with luteal phase defect. Vaginal route of progesterone supplementation has gained wide application mainly due to patient comfort and effectiveness. The use of human chorionic gonadotropin (hCG) may rescue the function of the failing corpus luteum in in vitro fertilization (IVF) cycles. In a prospective randomized study that compared the efficacy of luteal phase support (LPS) using either hCG, hCG in combination with daily vaginal progesterone or vaginal progesterone only, there were no statistically significant differences in the clinical ongoing pregnancy rate between the three groups. A recent trial evaluating the addition of oestrogen (E2) to vaginal progesterone in gonadotropin releasing hormone (GnRH) antagonist cycles showed that the endocrine profile was similar in the group that received progesterone and E2 or progesterone alone.
This chapter discusses the methods currently used for the assessment of ovarian reserve and the prediction of ovarian response to stimulation. It highlights that even when using very low follicle stimulating hormone (FSH) levels the accuracy in the prediction of ovarian reserve is only modest, making it inferior to other markers currently used. Antral follicle count (AFC) was found to correlate with, but was superior to, biochemical markers such as basal estradiol (E2), inhibin B, and FSH in predicting ovarian responsiveness. The combination of markers has been proposed for a better estimate of functional gonadal capacity. Ovarian reserve tests have only modest predictive value, especially in the prediction of occurrence of pregnancy and live birth. More studies are needed to evaluate the use of anti-Mullerian hormone (AMH) in conjunction with AFC in the prediction of ovarian reserve and ovarian response.
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