**10. Duration of luteal support**

Theoretically, progesterone would be of benefit to only 'fill in the gap' between clearance of exogenously administered hCG and the increase in endogenous hCG production. As soon as endogenous hCG production increases, the corpus luteum secretes an appropriate amount of progesterone [69].However most IVF centers extend luteal support for varying durations after positive pregnancy test. A questionnaire concerning details of luteal phase support was returned from 21 leading centers worldwide [70]. Micronized vaginal progesterone was used in 16 centers, one center used oral micronized progesterone, three centers used 50 mg I.M. progesterone and one center used hCG. All centers started luteal phase support on day of oocyte retrieval or day of embryo transfer. Luteal phase support was stopped on the day of [beta] hCG (BhCG) in eight centers, 2 weeks after positive B hCG in four centers, 2–4 weeks after positive B hCG in five centers, at 9, 10 and 11 weeks of pregnancy in three centers and at 12 weeks in one center. Schmidt et al. [69] compared two groups of patients who used luteal phase support for 2 or 5 weeks. The ongoing pregnancy rate and the delivery rates were not significantly different. The same Danish group [71] conducted a prospective randomized study on 303 women who achieved pregnancy after IVF or ICSI. All were treated with the long protocol using GnRH agonist and given luteal support with 200 mg vaginal progesterone three times daily during 14 days from the day of transfer until the day of a positive hCG test. The study group (n = 150) withdrew vaginal progesterone from the day of positive hCG. The control group (n = 153) continued administration of vaginal progesterone during the next 3 weeks of pregnancy. The study showed that the number of miscarriages prior to and after week 7 of gestation was seven (4.6%) and 15 (10.0%) in the study group and five (3.3%) and 13 (8.5%) in the control group, respectively. The number of deliveries was 118 (78.7%) in the study group and 126 (82.4%) in the control group. The differences were not significant. This is the first randomized study to conclude that prolongation of progesterone supplementation in early pregnancy has no influence on the miscarriage rate, and thus no effect on the delivery rate and progesterone supplementation can safely be withdrawn at the time of a positive hCG test

Luteal Phase Support in ART: An Update 167

**Author details** 

**12. References** 

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Corresponding Author

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Mohamad E. Ghanem\*

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*Mansoura Faculty of Medicine and Mansoura Integrated Fertility Center, Mansoura, Egypt* 

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