title: Which luteal phase support is better for each IVF stimulation protocol to achieve the highest pregnancy rate? A superiority randomized clinical trial.
abstract: In vitro fertilization (IVF) cycles generate abnormalities in luteal-phase sex steroid concentrations and this represent an important limiting factor to achieve a good pregnancy rate. Although there are evidences about the usefulness of luteal phase support (LPS) after IVF cycles, no consensus exist about the best dose and way of progesterone (PG) administration, the advantages of estradiol (E2) supplementation and which IVF protocol could benefit from one more than other LPS scheme. Aim of the study was to assess the best LPS (low-dose PG, high-dose PG, high-dose PG and E2 supplementation) to achieve the highest clinical/ongoing pregnancy rate according to stimulation protocol, E2 at ovulation induction, endometrial thickness at pick-up and women's age. We conducted a randomized trial on 360 women undergoing IVF (180 treated by long-GnRH agonist, 90 by short-GnRH agonist and 90 by short-GnRH antagonist protocol) and stimulated by recombinant follicle-stimulating hormone alone. Our data demonstrated that high-dose PG is better than low-dose to increase both clinical and ongoing pregnancy rate. E2 supplementation are mandatory in case of short-GnRH antagonist protocol and strongly suggested in all protocols when E2max <5 nmol/l and endometrial thickness <10 mm. In long-GnRH agonist protocols, as well as in patients >35 years, the real advantages of E2 supplementation remain debatable and require further confirmation.
authors.affiliation: a Department of Woman and Child Health, University of Padua Padova Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Gizzo
authors.affiliation: a Department of Woman and Child Health, University of Padua Padova Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Andrisani
authors.affiliation: a Department of Woman and Child Health, University of Padua Padova Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Esposito
authors.affiliation: a Department of Woman and Child Health, University of Padua Padova Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Noventa
authors.affiliation: a Department of Woman and Child Health, University of Padua Padova Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Di Gangi
authors.affiliation: b Department of Surgical Sciences, University of Cagliari Cagliari Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Angioni
authors.affiliation: a Department of Woman and Child Health, University of Padua Padova Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Litta
authors.affiliation: a Department of Woman and Child Health, University of Padua Padova Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Gangemi
authors.affiliation: a Department of Woman and Child Health, University of Padua Padova Italy.
authors.forename: Giovanni Battista
authors.initials: GB
authors.lastname: Nardelli
mesh_terms: D003340:Corpus Luteum Maintenance / Q000187:drug effects*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D004717:Endometrium / Q000187:drug effects; D004958:Estradiol / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods*; D005640:Follicle Stimulating Hormone / Q000008:administration & dosage / Q000627:therapeutic use; D007987:Gonadotropin-Releasing Hormone / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D006801:Humans; D008183:Luteal Phase / Q000187:drug effects*; D010062:Ovulation Induction / Q000379:methods*; D011247:Pregnancy; D018873:Pregnancy Rate; D011374:Progesterone / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome; D017329:Triptorelin Pamoate / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D017329:Triptorelin Pamoate; D007987:Gonadotropin-Releasing Hormone; D011374:Progesterone; D004958:Estradiol; D005640:Follicle Stimulating Hormone; C061018:ganirelix
keywords: Endometrium; GnRH agonist; GnRH antagonist; IVF protocol; estradiol; luteal phase support; pregnancy rate; progesterone