Health professionals
Murcian Health Service. Health Minister. Murcia region
All the documents consulted agree that it is not well established what the duration of progesterone supplementation should be during luteal phase support in in vitro fertilization; the available evidence does not seem to support its use beyond 8 weeks.
Uptodate’s summary of evidence on in vitro fertilization(1), explains that the duration of progesterone supplementation during luteal phase support is not clearly established. This is usually administered until a pregnancy test is performed (positive or negative) or throughout the first trimester. He also comments that the information from meta-analysis shows that estrogen supplementation does not improve pregnancy rates, although the use of estradiol together with vaginal progesterone is common to prevent bleeding at the end of the luteal phase.
According to SE of Dynamed on the treatment of infertility in women(2), the evidence does not support prolonging luteal phase support beyond 8 weeks’ gestation. This summary indicates that progesterone luteal phase support should be considered for in vitro fertilizations; Regarding estrogens, unlike Uptodate, he mentions that the addition of oral estradiol to progesterone could increase the clinical pregnancy rate in women with in vitro fertilization.
A systematic review published in 2019 on the role of luteal phase support in in vitro fertilization(3) concludes that progesterone should be maintained at least until a positive pregnancy test is available. And various narrative reviews(4-7) They also agree that this duration of progesterone treatment in support of the luteal phase is not well established.
These reviews mention, among others, a 2012 systematic review that concluded that progesterone could be unnecessary after the first positive determination of hCG * carried out after in vitro fertilization and several studies that found no differences in the results obtained with different strategies (suspend vs. maintain progesterone 3 weeks after the first positive pregnancy test; suspend vs. maintain progesterone after the first ultrasound that detects heartbeat; maintain it 5 vs. 8 weeks or 2 vs. 5 weeks).
* Human chorionic gonadotropin.
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