Luteal phase supplementation after gonadotropin releasing hormone agonist trigger in fresh embryo transfer The American versus European approaches

Capsule:
We describe two luteal phase support protocols after gonadotropin-releasing hormone agonist trigger: the European and the American approaches. Both concepts facilitate fresh embryo transfer with excellent reproductive outcomes in the ovarian hyperstimulation syndrome–risk patient.

Authors:
Peter Humaidan, M.D., Lawrence Engmann, M.D., Claudio Benadiva, M.D.

Volume 103, Issue 4, Pages 879-885

Abstract:

The challenges in attaining an adequate luteal phase after GnRH agonist (GnRHa) trigger to induce final oocyte maturation have resulted in different approaches focused on rescuing the luteal phase insufficiency so that a fresh transfer can be carried out without jeopardizing IVF outcomes. Over the years, two different concepts have emerged: intensive luteal support with aggressive exogenous administration of E2 and P; and low-dose hCG rescue in the form of a small dose of hCG either on the day of oocyte retrieva or on the day of GnRHa trigger (the so called “dual trigger”). Both approaches have been shown to be effective in achieving pregnancy rates similar to those obtained after conventional hCG trigger and resulting in a very low risk of ovarian hyperstimulation syndrome (OHSS). Although the idea of freezing all embryos after GnRHa trigger and transferring them in a subsequent frozen-thawed cycle has been gaining momentum, a fresh transfer leading to the live birth of a healthy child is currently considered to be the goal of IVF treatment.

  • J Metello

    Question: why is luteal support in frozen embrio transfer “so good” (with 800 mg vaginal progesterone and 6mg oral E2) and so bad after agnRH triggering and fresh transfer, even though there are so many corpus luteum producing hormones (although they are producing for shorter time)?

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