Timing luteal support in assisted reproductive technology A systematic review

Initiation of progesterone for luteal support may impact pregnancy rates (PRs). Starting progesterone before oocyte retrieval or 6 days after retrieval likely decreases PRs.

Matthew T. Connell, D.O., Jennifer M. Szatkowski, B.S., Nancy Terry, Alan H. DeCherney, M.D., Anthony M. Propst, M.D., Micah J. Hill, D.O.

Volume 103, Issue 4, Pages 939-946


To summarize the available published randomized controlled trial data regarding timing of P supplementation during the luteal phase of patients undergoing assisted reproductive technology (ART).

A systematic review.

Not applicable.

Undergoing IVF.

Different starting times of P for luteal support.

Main Outcome Measure(s):
Clinical pregnancy (PR) and live birth rates.

Five randomized controlled trials were identified that met inclusion criteria with a total of 872 patients. A planned meta-analysis was not performed because of a high degree of clinical heterogeneity with regard to the timing, dose, and route of P. Two studies compared P initiated before oocyte retrieval versus the day of oocyte retrieval and PRs were 5%–12% higher when starting P on the day of oocyte retrieval. One study compared starting P on day 6 after retrieval versus day 3, reporting a 16% decrease in pregnancy in the day 6 group. Trials comparing P start times on the day of oocyte retrieval versus 2 or 3 days after retrieval showed no significant differences in pregnancy.

There appears to be a window for P start time between the evening of oocyte retrieval and day 3 after oocyte retrieval. Although some studies have suggested a potential benefit in delaying vaginal P start time to 2 days after oocyte retrieval, this review could not find randomized controlled trials to adequately assess this. Further randomized clinical trials are needed to better define P start time for luteal support after ART.

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