During a normal menstrual cycle, progesterone prepares the endometrium for pregnancy by stimulating proliferation in response to human chorionic Gnadotropin produced by the corpus luteum. Many questions were raised about the role of follicular fluid aspiration on the granuloma cells at the time of oocyte retrieving during the ART cycles. Authors believes that oocyte retrieval might disrupt and/or diminish the number of granuloma cells undergoing luteinization, that results in a defective corpus luteum and abnormal progesterone production. As a result luteal phase would be defective in ART cycles. Many evidences support the need for providing luteal phase support in ART cycles. Various types of regimens were tried for the luteal phase support. Luteal support is initiated on the day of oocyte retrieval or on the morning after. Injectable form of progesterone or vaginal preparations was found as effective as repeated hCG injections. To avoid the risk of OHSS, the HCG is best avoided. Concerning the timing for discontinuing progesterone administration, needs for E2 support, and other products such as uterorelaxing factors remain debated. The best regimen for luteal support following triggering of ovulation by GnRH-a in GnRH antagonist cycles, remain a to be proved. This leads authors to recommend cryo-preservation when ovulation is triggered by an agonist. It is concluded that luteal phase support is mandatory in ART for optimizing otcome. Using progesterone preparation, should be offered to all ART patients, starting on the day of oocyte retrieval until anywhere from two to eight weeks after embryo transfer.
Materials and methods