Luteal support

Luteal support is the administration of medication, generally progesterone, progestins or GnRH agonists, to increase the success rate of implantation and early embryogenesis, thereby complementing and/or supporting the function of the corpus luteum.

The live birth rate is significantly higher with progesterone for luteal support in IVF cycles with or without intracytoplasmic sperm injection (ICSI). Co-treatment with GnRH agonists further improves outcomes, by a live birth rate RD of +16% (95% confidence interval +10 to +22%).

The main formulations of progesterone or progestins for luteal support are:

While daily intramuscular injections of progesterone-in-oil (PIO) have been the standard route of administration, PIO injections are not FDA-approved for use in pregnancy. A Cochrane review in 2015 stated that progesterone appears to be the best method of providing luteal phase support, but the evidence suggested the route of progesterone administration did not matter. A Cochrane review in 2011 found no evidence favoring a specific route of administration, dosage or duration of progesterone for luteal support.

Progestins used for luteal support include dydrogesterone and 17α-hydroxyprogesterone caproate

For egg donation, there is evidence of a lower pregnancy rate and a higher cycle cancellation rate when the progesterone supplementation in the recipient is commenced prior to oocyte retrieval from the donor, as compared to commenced day of oocyte retrieval or the day after.

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