title: The luteal phase after GnRH-agonist triggering of ovulation: present and future perspectives.
abstract: In stimulated IVF/intracytoplasmic sperm injection cycles, the luteal phase is disrupted, necessitating luteal-phase supplementation. The most plausible reason behind this is the ovarian multifollicular development obtained after ovarian stimulation, resulting in supraphysiological steroid concentrations and consecutive inhibition of LH secretion by the pituitary via negative feedback at the level of the hypothalamic-pituitary axis. With the introduction of the gonadotrophin-releasing hormone-(GnRH) antagonist, an alternative to human chorionic gonadotrophin triggering of final oocyte maturation is the use of GnRH agonist (GnRHa) which reduces or even prevents ovarian hyperstimulation syndrome (OHSS). Interestingly, the current regimens of luteal support after HCG triggering are not sufficient to secure the early implanting embryo after GnRHa triggering. This review discusses the luteal-phase insufficiency seen after GnRHa triggering and the various trials that have been performed to assess the most optimal luteal support in relation to GnRHa triggering. Although more research is needed, GnRHa triggering is now an alternative to HCG triggering, combining a significant reduction in OHSS with high ongoing pregnancy rates.
authors.affiliation: The Fertility Clinic, Odense University Hospital, Odense, Denmark. peter.humaidan@ouh.regionsyddanmark.dk
authors.forename: Peter
authors.initials: P
authors.lastname: Humaidan
authors.forename: E G
authors.initials: EG
authors.lastname: Papanikolaou
authors.forename: D
authors.initials: D
authors.lastname: Kyrou
authors.forename: B
authors.initials: B
authors.lastname: Alsbjerg
authors.forename: N P
authors.initials: NP
authors.lastname: Polyzos
authors.forename: P
authors.initials: P
authors.lastname: Devroey
authors.forename: Human M
authors.initials: HM
authors.lastname: Fatemi
mesh_terms: D002064:Buserelin / Q000627:therapeutic use*; D006063:Chorionic Gonadotropin / Q000627:therapeutic use; D002996:Clomiphene / Q000627:therapeutic use; D010064:Embryo Implantation / Q000187:drug effects; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists* / Q000037:antagonists & inhibitors; D006801:Humans; D008183:Luteal Phase / Q000187:drug effects / Q000502:physiology*; D007986:Luteinizing Hormone / Q000172:deficiency / Q000378:metabolism; D009292:Narcotic Antagonists / Q000627:therapeutic use; D054315:Oocyte Retrieval / Q000379:methods; D016471:Ovarian Hyperstimulation Syndrome / Q000517:prevention & control; D010062:Ovulation Induction / Q000379:methods*; D011247:Pregnancy
chemical_list: D006063:Chorionic Gonadotropin; D009292:Narcotic Antagonists; D002996:Clomiphene; D007987:Gonadotropin-Releasing Hormone; D007986:Luteinizing Hormone; D002064:Buserelin