title: Progesterone administration for luteal phase deficiency in human reproduction: an old or new issue?
abstract: Luteal phase deficiency (LPD) is described as a condition of insufficient progesterone exposure to maintain a regular secretory endometrium and allow for normal embryo implantation and growth. Recently, scientific focus is turning to understand the physiology of implantation, in particular the several molecular markers of endometrial competence, through the recent transcriptomic approaches and microarray technology. In spite of the wide availability of clinical and instrumental methods for assessing endometrial competence, reproducible and reliable diagnostic tests for LPD are currently lacking, so no type-IA evidence has been proposed by the main scientific societies for assessing endometrial competence in infertile couples. Nevertheless, LPD is a very common condition that may occur during a series of clinical conditions, and during controlled ovarian stimulation (COS) and hyperstimulation (COH) programs. In many cases, the correct approach to treat LPD is the identification and correction of any underlying condition while, in case of no underlying dysfunction, the treatment becomes empiric. To date, no direct data is available regarding the efficacy of luteal phase support for improving fertility in spontaneous cycles or in non-gonadotropin induced ovulatory cycles. On the contrary, in gonadotropin in vitro fertilization (IVF) and non-IVF cycles, LPD is always present and progesterone exerts a significant positive effect on reproductive outcomes. The scientific debate still remains open regarding progesterone administration protocols, specially on routes of administration, dose and timing and the potential association with other drugs, and further research is still needed.
authors.affiliation: Centre of Reproductive Medicine and Surgery, Arcispedale Santa Maria Nuova - IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy. stefanopalomba@tin.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Palomba
authors.affiliation: Centre of Reproductive Medicine and Surgery, Arcispedale Santa Maria Nuova - IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy. santagni.susanna@asmn.re.it.
authors.forename: Susanna
authors.initials: S
authors.lastname: Santagni
authors.affiliation: Centre of Reproductive Medicine and Surgery, Arcispedale Santa Maria Nuova - IRCCS, University of Modena and Reggio Emilia, Via Università 4, 41100 Viale Risorgimento 80, 42123, Modena, Italy. giovannibattista.lasala@asmn.re.it.
authors.forename: Giovanni Battista
authors.initials: GB
authors.lastname: La Sala
mesh_terms: D015925:Cryopreservation / Q000379:methods; D010064:Embryo Implantation / Q000187:drug effects; D004717:Endometrium / Q000502:physiology; D005260:Female; D005300:Fertility Agents, Female / Q000627:therapeutic use; D005307:Fertilization in Vitro / Q000379:methods; D006062:Gonadotropins / Q000627:therapeutic use; D006801:Humans; D007247:Infertility, Female / Q000188:drug therapy*; D008183:Luteal Phase / Q000187:drug effects*; D008599:Menstruation Disturbances / Q000188:drug therapy*; D016471:Ovarian Hyperstimulation Syndrome / Q000517:prevention & control; D010062:Ovulation Induction / Q000379:methods; D011374:Progesterone / Q000627:therapeutic use*; D011372:Progestins / Q000627:therapeutic use*; D027724:Reproductive Techniques, Assisted
chemical_list: D005300:Fertility Agents, Female; D006062:Gonadotropins; D011372:Progestins; D011374:Progesterone