- Title:
- A 10-year follow‐up on the practice of luteal phase support using worldwide web‐based surveys
- Journal:
- Reproductive Biology and Endocrinology
- Author(s):
- Gon Shoham1, Milton Leong2, Ariel Weissman3,4
- Author(s) affiliation:
- 1Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, P.O.B. 39040, 69978, Tel Aviv, Israel.
2The IVF Clinic, 13/F Central Tower, 28 Queens Road Central, Hong Kong, China
3Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, P.O.B. 39040, 69978, Tel Aviv, Israel
4IVF Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, 62 Halochamim Street, 5822012, Holon, Israel
- Short description:
- This longitudinal survey reveals that trends in the practice of luteal phase support have remained practically unchanged over a 10-year period, and shows a considerable gap between practice and science. Despite extensive research, the quality of evidence remains low for most luteal phase support topics, which emphasizes the need for further research.
- Link to the journal
Abstract taken from PubMed
- Background:
- It has been demonstrated that luteal phase support (LPS) is crucial in filling the gap between the disappearance of exogenously administered hCG for ovulation triggering and the initiation of secretion of endogenous hCG from the implanting conceptus. LPS has a pivotal role of in establishing and maintaining in vitro fertilization (IVF) pregnancies. Over the last decade, a plethora of studies bringing new information on many aspects of LPS have been published. Due to lack of consent between researchers and a dearth of robust evidence-based guidelines, we wanted to make the leap from the bench to the bedside, what are the common LPS practices in fresh IVF cycles compared to current evidence and guidelines? How has expert opinion changed over 10 years in light of recent literature?
- Methods:
- Over a decade (2009-2019), we conducted 4 web-based surveys on a large IVF-specialist website on common LPS practices and controversies. The self-report, multiple-choice surveys quantified results by annual IVF cycles.
- Results:
- On average, 303 IVF units responded to each survey, representing, on average, 231,000 annual IVF cycles. Most respondents in 2019 initiated LPS on the day of, or the day after egg collection (48.7 % and 36.3 %, respectively). In 2018, 72 % of respondents administered LPS for 8-10 gestational weeks, while in 2019, 65 % continued LPS until 10-12 weeks. Vaginal progesterone is the predominant delivery route; its utilization rose from 64 % of cycles in 2009 to 74.1 % in 2019. Oral P use has remained negligible; a slight increase to 2.9 % in 2019 likely reflects dydrogesterone's introduction into practice. E2 and GnRH agonists are rarely used for LPS, as is hCG alone, limited by its associated risk of ovarian hyperstimulation syndrome (OHSS).
- Conclusions:
- Our Assisted reproductive technology (ART)-community survey series gave us insights into physician views on using progesterone for LPS. Despite extensive research and numerous publications, evidence quality and recommendation levels are surprisingly low for most topics. Clinical guidelines use mostly low-quality evidence. There is no single accepted LPS protocol. Our study highlights the gaps between science and practice and the need for further LPS research, with an emphasis on treatment individualization.
- Link to the paper on PubMed
