Luteal-phase support in assisted reproduction treatment: real-life practices reported worldwide by an updated website-based survey.
An updated worldwide web-based survey assessed the real-life clinical practices regarding luteal-phase supplementation (LPS) in assisted reproduction. This survey looked for changes since a former survey conducted nearly 3years earlier. The survey questions were: If you support the luteal phase, when do you start the regimen you are using?; Which agent/route is your treatment of choice to support the luteal phase?; If you use vaginal progesterone, which formulation do you use?; and How long you continue progesterone supplementation if the patient conceived? Data were obtained from 408 centres (82 countries) representing 284,600 IVF cycles/year. The findings were: (i) most practitioners (80% of cycles) start LPS on the day of egg collection; (ii) in >90%, a vaginal progesterone product is used (77% as a single agent and 17% in combination with i.m. progesterone), while human chorionic gonadotrophin as a single agent for LPS is not being used at all; and (iii) in 72% of cycles, LPS is administered until 8-10weeks' gestation or beyond. When compared with the initial survey, the results of this survey are encouraging as there is a clear shift towards a more unified and evidence-based approach to LPS in IVF cycles. This updated worldwide web-based survey assessed the actual real-life clinical practices regarding luteal-phase supplementation (LPS) in assisted reproduction. Specifically, this survey looked for changes since an initial survey conducted nearly 3years earlier. The survey included the following questions: If you support the luteal phase, when do you start the regimen you are using?; Which agent/route is your treatment of choice to support the luteal phase?; If you use vaginal progesterone, which formulation do you use?; and How long you continue progesterone supplementation if the patient conceived? Data from 408 centres in 82 countries representing a total of 284,600 IVF cycles/year were included. Most practitioners (80% of cycles) start LPS on the day of egg collection and in more than 90% a vaginal progesterone product is used for LPS (in 77% as a single agent and in 17% in combination with i.m. progesterone). As a single agent for LPS, human chorionic gonadotrophin is not being used at all. Regarding the duration of supplementation, in 72% of cycles, LPS is administered until 8-10weeks' gestation or beyond. When compared with the initial survey from 2009, the results of this updated survey are encouraging as there is a clear shift towards a more unified and evidence-based approach to luteal-phase support in IVF cycles. Nevertheless, although there is no firm evidence supporting the continuation of LPS after the demonstration of fetal heart beat on ultrasound, this remains the common practice of the majority of assisted reproduction centres worldwide.
Department of Obstetrics and Gynecology, Kaplan Medical Center (Affiliated with the Hebrew University of Jerusalem and Hadassah School of Medicine, Jerusalem, Israel), Rehovot, Israel. Electronic address: evaisbuch@gmail.com.
Edi
E
Vaisbuch
Division Reprod. Endocr. and Infertility, Université Paris Descartes-Hôp. Cochin, Paris, France.
Dominique
D
de Ziegler
IVF Centre, the Hong Kong Sanatorium and Hospital, Happy Valley, Hong Kong.
Milton
M
Leong
IVF Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Ariel
A
Weissman
Department of Obstetrics and Gynecology, Kaplan Medical Center (Affiliated with the Hebrew University of Jerusalem and Hadassah School of Medicine, Jerusalem, Israel), Rehovot, Israel.
Zeev
Z
Shoham
D002985:Clinical Protocols; D005260:Female; D006801:Humans; D008183:Luteal Phase / Q000187:drug effects*; D011247:Pregnancy; D011374:Progesterone / Q000008:administration & dosage / Q000627:therapeutic use*; D027724:Reproductive Techniques, Assisted; D013997:Time Factors
D011374:Progesterone
ART; IVF; LPS; human chorionic gonadotrophin; luteal phase; progesterone