A survey on luteal-phase progesterone support
Luteal-phase progesterone support during stimulated IVF cycles is considered mandatory to counter luteal insufficiency that might have a negative effect on implantation. Fortunately, there have been major advancements in both luteal-phase progesterone formulations and other drug and protocol options in recent years. With the forthcoming survey of the IVF community, we would like to assess current and emerging solutions for luteal-phase support, in terms of knowledge, experience, utilization and outcomes.
Which factor is most important to you when deciding which luteal support regimen to use?
- Evidence-based data from the literature
- Your personal experience
- Cost of medication
- Patients’ convenience
- Published Guidelines
In most cases, how do you determine which luteal support regimen to use for your patients?
- I use the same luteal support regimen for all patients
- I individualize luteal support regimens (according to each patient’s ovarian response, stimulation protocol, age, BMI, etc.)
- None of the above
If you support the luteal phase, when do you start the regimen you use?
- On the day of hCG administration
- On the day after hCG administration
- On the day of egg collection
- On the day after egg collection
- On the day of embryo transfer
- A few days after embryo transfer
- Other
- I do not support the luteal phase
How long do you continue progesterone supplementation if the patient conceives?
- Until pregnancy is confirmed in a blood or urine test (week 4) or 14 days after embryo transfer
- Until the presence of a fetal heartbeat
- Until gestational week 8–10
- Until gestational week 10-12
- Until gestational week 13-15
- Longer than 16 weeks
- I do not administer progesterone
In the majority of the cases, which agent/route is your treatment of choice to support the luteal phase?
- hCG
- Vaginal progesterone
- IM progesterone
- Sub-cutaneous progesterone
- Oral progesterone
- GnRH agonist nasal spray
- A combination of the drugs/routes mentioned above
- Other
- I do not support the luteal phase
If you use a combination of progesterone treatments, which do you prefer?
- Vaginal and IM/sub-cutaneous progesterone
- Vaginal and oral progesterone
- IM/sub-cutaneous and oral progesterone
- Vaginal, IM/sub-cutaneous, and oral progesterone
- Other
- I do not use a combination of progesterone treatments
If you use vaginal progesterone, which formulation do you prefer to use in the majority of cases?
- Vaginal progesterone in gel form (such as Crinone)
- Vaginal suppositories (such as Endometrin)
- Vaginal tablets (such as Utrogestan)
- Vaginal pessary (such as Cyclogest)
- Other
- I do not use vaginal progesterone
If you use oral progesterone, which drug do you prefer?
- Micronized progesterone (such as Utrogestan)
- Medroxyprogesterone acetate (such as Provera)
- Dydrogesterone (such as Duphaston)
- Norethisterone (such as Primolut-Nor)
- I do not use oral progesterone
If you use IM progesterone, which interval/formulation do you prefer?
- Daily progesterone in oil (Gestone, Prontogest, etc.)
- Long-acting P preparation: Hydroxyprogesterone caproate (Progesterone Retard, Proluton, etc.)
- A different interval of administration or formulation
- I do not use IM progesterone
Do you include estradiol in your luteal support regimen?
- Yes, always
- Yes, but only in selected cases
- No, I do not use estradiol for luteal support
When triggering ovulation with a GnRH agonist, which luteal support do you use?
- Always "freeze all" with no luteal support
- "Intensive" luteal support, e.g., higher doses of progesterone and estrogen
- Low doses of hCG
- GnRH agonist nasal spray
- None of the above
If all progesterone formulations were found to yield the same live birth rates, which route would you prefer to use?
- Oral
- Vaginal
- Subcutaneous
- IM
- Combined of the above drugs
- No preference
Are more studies needed to reach a decision on the efficacy of the various luteal phase support formulations, or is there enough evidence in the literature already?
- Yes, more studies are needed
- No more studies are needed; there is already enough data in the literature to reach a decision
I would like to see more research data about the following routes/formulations:
- Oral
- Subcutaneous
- IM
- Vaginal
- There is no need for additional data
Do you treat patients during the luteal phase if you suspect they have a hyperactive immune system due to inflammation, autoimmunity, etc.?
- Yes
- No
- I do not support the luteal phase
Do you routinely measure progesterone levels during the supplemented luteal phase?
- Yes
- No
- I do not support the luteal phase
