Has ART Finally Got a Patient-Friendly Progesterone?

Abstract

Progesterone prepares the endometrium for pregnancy by stimulating proliferation in response to human chorionic gonadotropin (hCG), which is produced by the corpus luteum. This occurs in the luteal phase of the menstrual cycle. In assisted reproduction techniques (ART), the progesterone or hCG levels, or both, are low, and the natural process is insufficient, so the luteal phase is supported with either progesterone, hCG, or gonadotropin-releasing hormone (GnRH) agonists. Luteal phase support improves implantation rate and thus pregnancy rates, but the ideal method is still unclear. A large recent Cochrane review showed a significant effect in favor of progesterone for luteal phase support, favoring synthetic progesterone over micronized progesterone [1]. Overall, the addition of other substances such as estrogen or hCG did not seem to improve outcomes. Those authors also found no evidence favoring a specific route or duration of administration of progesterone. They found that hCG, or hCG plus progesterone, was associated with a higher risk of ovarian hyperstimulation syndrome (OHSS). The use of hCG should therefore be avoided [1]. There were significant results showing beneficial effects from the addition of GnRH agonist to progesterone in terms of the outcomes of live birth, clinical pregnancy, and ongoing pregnancy. For now, progesterone seems to be the best option as luteal Gautam N Allahbadia is the Editor-in-chief of the Journal of Obstetrics & Gynecology of India as well as the IVF Lite (Journal of Minimal Stimulation IVF) and Medical Director at Rotunda—The Center For Human Reproduction, Mumbai, India & New Hope IVF, Sharjah, UAE.