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  • Print publication year: 2021
  • Online publication date: March 2021

Chapter 7 - Luteal Support

from Section 2 - Assisted Reproductive Procedures


The corpus luteum (CL) is a transitory endocrine gland that develops from the postovulatory ruptured follicle during the luteal phase. Human chorionic gonadotropin (hCG), produced by the embryo, maintains the secretory activity of the CL due to its structural similarity to luteinizing hormone (LH) and subsequent activation of the same receptor. It maintains and stimulates the CL to produce estradiol (E2) and progesterone (P4). Luteal P4 is involved in the transition of the endometrium from a proliferative to a secretory type, with increasing decidualization – an essential facilitator of implantation [1] – and relaxation of the uterine muscle. Preparation of the endometrium lining the uterus for implantation of the embryo begins toward the end of a proliferative phase and extends throughout the luteal phase. This is important for the implantation process and maintenance of pregnancy until the placenta takes over steroid hormone production at approximately 7 weeks.

1.Jabbour, HN, Kelly, RW, Fraser, HM, Critchley, HO. Endocrine regulation of menstruation. Endocr. Rev. 2006; 27:1746.
2.Garcia, J, Jones, GS, Acosta, AA, Wright, GL. Corpus luteum fuction after follicle aspiration for oocyte retrieval. Fertil. Steril. 1981; 36:565572.
3.Fatemi, HM, Popovic-Todorovic, B, Papanikolaou, E, Donoso, P, Devroey, P. An update of luteal phase support in stimulated IVF cycles. Hum. Reprod. Update 2007; 13:581590.
4.O’Neill, C, Ferrier, AJ, Vaughan, J, Sinosich, MJ, Saunders, DM. Causes of implantation failure after in-vitro fertilization and embryo transfer. Lancet 1985; 2:615.
5.The ESHRE Capri Workshop Group. Anovulatory infertility. Hum. Reprod. 1995; 10:15491553.
6.Duncan, WC. A guide to understanding polycystic ovary syndrome (PCOS). J. Fam. Plann. Reprod. Health Care 2014; 40:217225.
7.Mackens, S, Santos-Ribeiro, S, van de Vijver, A, et al. Frozen embryo transfer: a review on the optimal endometrial preparation and timing. Hum. Reprod. 2017; 32:22342242.
8.Kutlusoy, F, Guler, I, Erdem, M, et al. Luteal phase support with estrogen in addition to progesterone increases pregnancy rates in in-vitro fertilization cycles with poor response to gonadotropins. Gynecol. Endocrinol. 2014; 30:363366.
9.Ho, CH, Chen, SU, Peng, FS, Chang, CY, Yang, YS. Luteal support for IVF/ICSI cycles with Crinone 8% (90 mg) twice daily results in higher pregnancy rates than with intramuscular progesterone. J. Chin. Med. Assoc. 2008; 71:386391.
10.Barbosa, MW, Silva, LR, Navarro, PA, et al. Dydrogesterone vs progesterone for luteal-phase support: systematic review and meta-analysis of randomized controlled trials. Ultrasound Obstet. Gynecol. 2016; 48:161170.
11.Saccone, G, Khalifeh, A, Elimian, A, et al. Vaginal progesterone vs intramuscular 17α-hydroxyprogesterone caproate for prevention of recurrent spontaneous preterm birth in singleton gestations: systematic review and meta-analysis randomized controlled trials. Ultrasound Obstet. Gynecol. 2017; 49:315321.
12.Child, T, Leonard, SA, Evans, JS, Lass, A. Systematic review of the clinical efficacy of vaginal progesterone for luteal phase support in assisted reproductive technology cycles. RBM Online 2018; 36:630645.
13.Tournaye, H, Sukhikh, G, Kuhler, E, Griesinger, G. A phase III randomized controlled trial comparing the efficacy, safety and tolerability of oral dydrogesterone versus micronized vaginal progesterone for luteal support in in vitro fertilization. Hum. Reprod. 2017; 32:10191027.
14.Baker, V, Jones, C, Doody, K, et al. A randomized controlled trial comparing the efficacy and safety of aqueous subcutaneous progesterone with vaginal progesterone for luteal phase support of in vitro fertilization. Hum. Reprod. 2014; 29:22102220.
15.Kleinstein, J. Efficacy and tolerability of vaginal progesterone capsules (Utrogest 200) compared with progesterone gel (Crinone 8%) for luteal phase support during assisted reproduction. Fertil. Steril. 2005; 83:16411649.
16.Penzias, A. Luteal phase support. Fertil. Steril. 2002; 77:318323.
17.van der Linden, M, Buckingham, K, Farquhar, C, Kremer, JA, Metwally, M. Luteal phase support for assisted reproduction cycles. Cochrane Database Syst. Rev. 2015; CD009154. doi:10.1002/14651858.CD009154.
18.Hutchison, JS, Zeleznik, AJ. The corpus luteum of the primate menstrual cycle is capable of recovering from a transient withdrawal of pituitary gonadotropin support. Endocrinology 1985; 117:10431049.
19.Liu, X, Mu, H, Shi, Q, Xiao, X, Qi, H. The optimal duration of progesterone supplementation in pregnant women after IVF/ICSI: a meta-analysis. Reprod. Biol. Endocrinol. 2012; 10:107115.
20.Thomsen, LH, Kesmodel, US, Erb, K, et al. The impact of luteal serum progesterone levels on live birth rates-a prospective study of 602 IVF/ICSI cycles. Hum. Reprod. 2018; 33:15061516. doi:10.1093/humrep/dey226.
21.Silver, RI. Endocrine abnormalities in boys with hypospadias. Adv. Exp. Med. Biol. 2004; 545:4572.
22.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. RBM Online 2014; 28:330335.