Showing 11 results for Luteal Phase
Mahmoud Hashemitabar, Babak Ghavamizadeh, Fatemea Javadnia, Esmaiel Sadain,
Volume 2, Issue 1 (7-2004)
Abstract
Background: The luteal phase defect is a common event following the ovarian stimulation. The aim of the present study was to evaluate the use of human chorionic gonadotropine (hCG) and progesterone hormones to improve the luteal phase defect. Materials and Methods: 60 mice were superovulated routinely with human menopausal gonadotropin (hMG) (7.5U) and hCG (10U). The mice were mated and divided into 3 groups: 1- control (n=20) 2- hCG treatment (n= 20), and 3-Progesterone treatment (n=20). Each group was divided again into two subgroups. The mice (10 from each group) had no injection in group one and were injected intraperiteneal (IP) by hCG (5U/day) and progesterone (1mg/day) subcutaneously (sc) in groups 2 and 3, respectively for four days. On the day 5, the animals were killed by cervical dislocation and the uterus were flushed to count the number of blastocyst and their quality. The above treatment were carried out for 12 days in the other 10 mice in each group. Similarly group one had no injection and groups 2 and 3 were injected by hCG and progesterone for 12 days respectively by the same manner as mention above. The animals were killed on day 13 and the implanted embryos were counted. The uterus and ovary were processed on days 5 and 13 of pregnancy for histological studies. Results: The mean number of blastocysts per mouse were: 12.2%, 2.6% and 3% in group 1 to 3, respectively. The nomber of implanted embryos were 29 as: 13 living fetus in one mouse and 16 resorption fetus in the other. The morphology of uterus on day 5 was as follow: no development in the stroma and endometrial gland in control group, the stroma and endometrial gland so developed to form the saw teeth appearance which indicated on receptivity of uterus in hCG treated group similar to progesterone treated group, but without the saw teeth appearance. The continuation of hCG injection maintained the receptivity of uterus; while, the continuation in progesterone caused metaplesia of epithelium. The morphology of ovaries in all three groups showed no changes in corpus luteum size on day 5, and showed the following changes on day 13: increasing the number of primary and secondary follicles in control group; while, reducing the size of corpus luteum in hCG group. Conclusion: Progesterone did not improve the uterus and implantation rate. The prolonged usage of progesterone can change the morphology of uterus to more abnormal state in conterast to the prolonged usage of hCG.
Behrooz Niknafs, Fathemeh Afshari, Abdo-Rahman Dezfulian,
Volume 6, Issue 4 (7-2008)
Abstract
Background: The application of luteal phase supplementation hormones to increase the implantation rate is on debate among researchers.
Objective: In this study, the morphological and morphometrical assessment of superovulated mice endometrium were investigated at window implantation period superovulated mice.
Materials and Methods: Female mice were superovualated then were mated with vasectomized mice; the mice were divided in experimental and control groups. Experimental group included five groups which in them pseudopregnant mice were given a four consecutive daily injection of 1-progesterone (P), 2-estrogen (E), 3-estrogen + progesterone, 4-antiprogesterone+estrogen and 5-sham group. The uterine of all groups were collected after 4.5 day of pseudopregnancy and were prepared for histological and morphometrical studies.
Results: Morphological studies of endometrial tissue showed that the luminal epithelium in group P appeared cuboidal shape. Endometrial folding was very high in group E+P. The luminal epithelium in groups E, E+P and RU 486 + E were seen in different morphology in comparison to control group. Morphometrical evaluation also showed height of luminal epithelium in group E (32.7±0.67) and E+P (33.6±1.3) were higher than those were seen in control (22.5±1.5) and group P (15.3±1.2).
Conclusion: Progesterone caused the lowest endometrial development compare to other groups. It is concluded that the adding of E to P may improve endometrial condition to implant at luteal phase.
Ashraf Moini, Fatemeh Zafarani, Bita Eslami, Maria Sadeghi, Zahra Kamyabi, Nadia Jahangiri,
Volume 9, Issue 2 (7-2011)
Abstract
Background: Supplementation of luteal phase with progesterone is prescribed for women undergoing routine IVF treatment.
Objective: The objective of this study was to compare the efficacy of three types of progesterone on biochemical, clinical and ongoing pregnancy rates and abortion and live birth rates.
Materials and Methods: A prospective randomized study was performed at Royan Institute between March 2008 and March 2009 in women under 40 years old, who use GnRH analog down-regulation. One hundred eighty six patients in three groups were received progesterone in oil (100 mg, IM daily), intravaginal progesterone (400 mg, twice daily) and 17-a hydroxyprogestrone caproate (375mg, every three days), respectively.
Results: Final statistical analysis after withdrawal of some patients was performed in 50, 50 and 53 patients in group 1, 2 and 3 respectively. No differences between the groups were found in baseline characteristics. No statistical significance different was discovered for biochemical, clinical and ongoing pregnancies. Although the abortion rate was statistically higher in group 1 (p=0.025) the live birth rate was not statistically significant between the three groups.
Conclusion: The effects of three types of progesterone were similar on pregnancies rate. We suggest the use of intravaginal progesterone during the luteal phase in patients undergoing an IVF-ET program because of the low numbers of abortions, and high ongoing pregnancy rates.
Bibi Shahnaz Aali, Sakineh Ebrahimipour, Siavash Medhdizadeh,
Volume 11, Issue 4 (6-2013)
Abstract
Background: Controlled ovarian stimulation combined with intra uterine insemination (IUI) is a convenient treatment of infertility with a success rate of 11%. The clinical observation and pattern of progesterone secretion in this method is suggestive of luteal phase defect and postulated as an implicating factor of treatment failure.
Objective: To investigate the efficacy of luteal phase support with intravaginal cyclogest in women undergoing controlled ovarian stimulation combined with intrauterine insemination.
Materials and Methods: In this single-blinded clinical trial, 196 consecutively seen women eligible for the study protocol, were randomized to receive either intravaginal progesterone (cyclogest pessary, Actavis) or no medication in luteal phase. Blood samples were collected and serum progesterone level in 7th and 11th day of the cycle, biochemical and clinical pregnancy and luteal phase duration were compared in case and control groups.
Results: The mean age in case and control group was 28 and 27.9 years, respectively and the most frequent cause of infertility was unexplained. Additionally, ovulatory dysfunction was the most common cause of female infertility in both groups. Based on these variables, there was no statistically significant difference between the two groups. Mean serum progesterone level in the case group were 48.34 and 34.24nmol/day on day 7 and 11 after insemination, respectively and both values were significantly higher than the control group. There was no difference between the two groups in terms of biochemical and clinical pregnancy. Luteal phase duration in the case group was significantly longer than the control group.
Conclusion: Luteal phase support by Cyclogest pessary increases progesterone level and prolongs the luteal phase, but does not affect success rate of IUI cycles in terms of achieving pregnancy.
Robab Davar, Maryam Farid Mojtahedi, Sepideh Miraj,
Volume 13, Issue 8 (9-2015)
Abstract
Background: There is no doubt that luteal phase support is essential to enhance the reproductive outcome in IVF cycles. In addition to progesterone and human chorionic gonadotropin, several studies have described GnRH agonists as luteal phase support to improve implantation rate, pregnancy rate and live birth rate, whereas other studies showed dissimilar conclusions. All of these studies have been done in fresh IVF cycles.
Objective: To determine whether an additional GnRH agonist administered at the time of implantation for luteal phase support in frozen-thawed embryo transfer (FET) improves the embryo developmental potential.
Materials and Methods: This is a prospective controlled trial study in 200 FET cycles, patients were randomized on the day of embryo transfer into group 1 (n=100) to whom a single dose of GnRH agonist (0.1 mg triptorelin) was administered three days after transfer and group 2 (n=100), who did not receive agonist. Both groups received daily vaginal progesterone suppositories plus estradiol valerate 6 mg daily. Primary outcome measure was clinical pregnancy rate. Secondary outcome measures were implantation rate, chemical, ongoing pregnancy rate and abortion rate.
Results: A total of 200 FET cycles were analyzed. Demographic data and embryo quality were comparable between two groups. No statistically significant difference in clinical and ongoing pregnancy rates was observed between the two groups (26% versus 21%, p=0.40 and 21% versus 17%, p=0.37, respectively).
Conclusion: Administration of a subcutaneous GnRH agonist at the time of implantation does not increase clinical or ongoing pregnancy.
Maryam Eftekhar, Banafsheh Mohammadi, Esmat Mangoli, Maryam Mortazavi,
Volume 18, Issue 11 (11-2020)
Abstract
Background: Endometrial receptivity is one of the important factors in assisted reproductive technology (ART) success. In the luteal phase of an ART cycle, serum estradiol (E2) and progesterone are often placed in low levels. Supporting the luteal phase with progesterone is a usual method.
Objective: To evaluate the effects of E2 supplementation plus progesterone on the luteal phase support in the antagonist protocol who have undergone intracytoplasmic sperm injection-embryo transfer cycles.
Materials and Methods: In this cross-sectional study, 200 patients with antagonist stimulation protocol, who had undergone intracytoplasmic sperm injection treatment, were divided into two groups based on the use of E2 supplementation. In both groups, 400 mg progesterone suppositories (Cyclogest®), twice a day/vaginally, was administered starting from the day of oocyte collection until the fetal heart activity. However, in the E2 group, in addition to progesterone, 4 mg tablet of E2 was received daily. Beta hCG was checked 14 days after the embryo transfer, and the clinical pregnancy rate was the main endpoint.
Results: The patients’ characteristics were matched, and insignificant differences were observed, except for endometrial thickness. The clinical outcomes showed the rate of pregnancy was higher in the E2 group compared to the control group; nonetheless, statistically, there was no noticeable difference.
Conclusion: E2 supplementation had no beneficial effect in the luteal phase support of IVF cycles. Nevertheless, more studies are required to confirm the supportive role of E2 supplementation for embryo implantation and to improve the outcomes in ART cycles.
Maryam Eftekhar, Maryam Mirzaei, Esmat Mangoli, Yasamin Mehrolhasani,
Volume 19, Issue 7 (7-2021)
Abstract
Background: The effect of adding gonadotropin-releasing hormone (GnRH) agonist on the luteal phase support in assisted reproductive technique (ART) cycles is controversial.
Objective: To determine the effects of adding multiple doses of GnRH agonist to the routine luteal phase support on ART cycle outcomes.
Materials and Methods: In this clinical trial study, 200 cases who underwent the antagonist protocol at the Research and Clinical Center for Infertility, Yazd, Iran, between January and March 2020 participated. From them, 168 cases had inclusion criteria and equally divided into 2 groups. After receiving progesterone in the luteal phase in both groups, while the case group received GnRH agonist subcutaneously (0/1 mg triptorelin) zero, three, and six days after the fresh embryo transfer, the control group did not receive anything. Finally, chemical and clinical pregnancy rates, number of mature oocytes, fertilization rate, total dose of gonadotropin, and the estradiol level were determined.
Results: The baseline characteristics were similar in both groups. No significant difference was observed between embryo transfer cycles. Clinical results showed that the differences between the fertilization rate, chemical and clinical pregnancy were not significant.
Conclusion: The results showed that receiving multiple doses of GnRH agonist in the luteal phase of ART cycles neither improves embryo implantation nor the pregnancy rates; therefore, further studies are necessary.
Saeideh Dashti, Maryam Eftekhar,
Volume 19, Issue 9 (9-2021)
Abstract
It has been shown that in controlled ovarian hyper stimulation cycles, defective luteal phase is common. There are many protocols for improving pregnancy outcomes in women undergoing fresh and frozen in vitro fertilization cycles. These approaches include progesterone supplements, human chorionic gonadotropin, estradiol, gonadotropin-releasing hormone agonist, and recombinant luteinizing hormone. The main challenge is luteal-phase support (LPS) in cycles with gonadotropin-releasing hormone agonist triggering. There is still controversy about the optimal component and time for starting LPS in assisted reproductive technology cycles. This review aims to summarize the various protocols suggested for LPS in in vitro fertilization cycles.
Afsoon Zareii, Sara Davoodi, Mahshid Alborzi, Marzieh Eslami Moghadam, Elham Askary,
Volume 19, Issue 10 (10-2021)
Abstract
Background: Since progesterone alone does not seem to be enough for luteal phase support (LPS), especially in frozen embryo transfer (FET) cycles, so gonadotropin-releasing hormone agonist (GnRH-a) is suggested as an adjuvant therapy in combination with progesterone for LPS.
Objective: To evaluate the effects of the administration of GnRH-a with vaginal progesterone compared to vaginal progesterone alone in luteal phase support of the frozen-thawed embryo transfer cycles.
Materials and Methods: In this randomized controlled clinical trial, 240 infertile women who were candidate for FET were evaluated into two groups (n = 120/each). Group I received 400 mg vaginal progesterone twice a day from the time of transfer. Second group received vaginal progesterone and also 0.1 mg diphereline on days 0, 3, and 6 of FET for LPS. Finally, the clinical and ongoing pregnancy rates, and the implantation, and spontaneous abortion rates were compared in two groups.
Results: Results showed that there was no significant difference between the mean age of women and the duration of infertility (p = 0.78, p = 0.58, respectively). There were no significant differences between groups in the terms of implantation and spontaneous abortion rates (p = 0.19, p = 0.31, respectively). However, in terms of clinical and ongoing pregnancy rates, the significant differences were seen between groups (p = 0.008 and p = 0.005, respectively).
Conclusion: Co-administration of GnRH-a and vaginal progesterone in LPS may be superior to vaginal progesterone alone in women who underwent a frozen-selected embryo transfer cycle.
Samaneh Jalaliani, Robab Davar, Farzad Akbarzadeh, Fatemeh Emami, Maryam Eftekhar,
Volume 20, Issue 9 (9-2022)
Abstract
Background: Luteal phase deficiency is common in assisted reproductive technology and is characterized by inadequate progesterone production. Various studies have shown that administration of progesterone in fresh embryo transfer cycles increases the rate of clinical pregnancy and live birth rate. Progesterone administration has variable types: oral, vaginal, oil-based intramuscular, and subcutaneous.
Objective: This study aims to compare the effect of adding intramuscular progesterone to the vaginal progesterone for luteal phase support in the fresh embryo transfer cycle.
Materials and Methods: This study reviewed the information related to 355 women who had a fresh embryo transfer between March 2020 and February 2021 at the Yazd Reproductive Sciences Institute, Yazd, Iran. The participants population were divided into 2 groups based on the type of luteal phase support regime: group I (n = 173) received 400 mg vaginal progesterone alone twice a day from the day of ovum pick up; and group II (n = 182) received 50 mg IM of progesterone in addition to vaginal progesterone 400 mg twice a day from the day of ovum pick up. Chemical and clinical pregnancy rates were compared between groups.
Results: The basic characteristics of groups were statistically similar. The rates of chemical and clinical pregnancy were higher in the vaginal plus IM progesterone group than in the vaginal progesterone group. Moreover, chemical pregnancy showed a significant difference between the groups (p = 0.011).
Conclusion: Our findings demonstrated that the addition of IM progesterone to the vaginal progesterone improves the chemical pregnancy rate in fresh embryo transfer.
Sahereh Arabian, Maryam Eftekhar, Saeideh Dashti, Nahid Homayoon, Elham Nikfarjam,
Volume 22, Issue 10 (10-2024)
Abstract
Background: Currently, frozen embryo transfers (FET) account for 41% of all embryo transfer cycles. Vaginal progesterone preparations have become the leading choice for luteal phase support due to their convenient application; however, using only vaginal progesterone during FET cycles results in a lower ongoing pregnancy rate.
Objective: This study aimed to investigate whether replacing intramuscular (IM) progesterone with oral dydrogesterone in FET cycles affects pregnancy outcomes or not.
Materials and Methods: In this cross-sectional study, pregnancy outcomes were analyzed in women who underwent cleavage stage FET during an endometrial preparation cycle using hormone replacement therapy at Yazd Reproductive Sciences Institute, Yazd, Iran, between April 2023 and November 2023. The study examined 2 groups based on a luteal phase support regimen: the dydrogesterone group, which received vaginal progesterone and oral dydrogesterone, and the IM progesterone group, which received vaginal progesterone and IM progesterone. Data were extracted from patient files to compare outcomes between the 2 groups.
Results: A total of 960 cycles meeting the inclusion criteria were analyzed, with 292 women in the dydrogesterone group and 668 women in the IM progesterone group, and pregnancy outcomes were compared between the 2 groups. The chemical pregnancy rates (28.4% vs. 29.9%, p = 0.636), clinical pregnancy rates (25.3% vs. 26.9%, p = 0.604), and ongoing pregnancy rates (21.9% vs. 23.8%, p = 0.525) were lower and miscarriage rates (14.7% vs. 11.7%, p = 0.210) were higher in dydrogesterone group compared to IM progesterone group, although this difference was not statistically significant.
Conclusion: Based on the ease of use and similar pregnancy outcomes of oral dydrogesterone, it can potentially replace the daily injections of IM progesterone.
