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BOOK TITLE: Principles and Practice of Assisted Reproductive Technology
Luteal phase support (LPS) is mandatory in assisted reproductive technology (ART) cycles to optimize reproductive outcomes. Progesterone and human chorionic gonadotropin (hCG) use in the luteal phase confers benefit to infertile women undergoing in vitro fertilization (IVF) treatment. Use of hCG for trigger is associated with greater risk of ovarian hyperstimulation syndrome (OHSS). Natural micronized progesterone as a luteal phase agent is not effective if taken orally. Vaginal and injectable progesterone have similar implantation and clinical pregnancy rates. Synthetic progesterone, dydrogesterone, has been found to be equally effective as vaginal micronized progesterone for LPS in ART cycles. Concomitant use of estrogen with progesterone does not seem to enhance the probability of implantation and pregnancy rates. Gonadotropin-releasing hormone agonist along with progesterone may have a promising role in improving IVF outcomes but more studies are needed to adopt this approach. Optimal timing of LPS is important, the window of starting LPS being within 24–48 hours from the oocyte retrieval. Modified LPS in gonadotropin-releasing hormone agonist triggered cycles in the form of hCG bolus and recombinant luteinizing hormone has shown positive effect on pregnancy outcomes, but more studies are needed to support its use.