Luteal phase support

Introduction

Luteal phase is a second phase in menstrual cycle which occurs after ovulation. This phase is where the corpus luteum is formed and produce progesterone hormone. This phase is important as the preparation for the endometrium wall for the embryo to implant.

Procedure

Unlike in normal menstrual cycle, corpus luteum are not able to provide enough estrogen and progesterone hormone in IVF procedure. This situation will disturb the luteal phase and will affect the quality endometrium wall for the embryo to implant. Thus, hormone support is very important to increase the success rate in IVF. Normally, hormone will be given in several ways which includes:

1. Injection of low dose of HCG few days apart to stimulate the production of progesterone hormone from corpus luteum.
2. Progesterone support either in the form of vaginal progesterone, intramuscular progesterone or oral progesterone.

Success rate of IVF closely related to few factors such as woman’s age, cause of infertility and laboratory in handling the IVF treatment. Succesful rate of IVF treatment is low if the woman’s age is more than 40 years old because of the number of follicle is less and poorerquality of the ovum. Generally, succesful rate in IVF is between 25-35 percent for each cycle depends on the above factors. Luteal phase support will be provided until the result from the IVF procedure is obtained (depends on the results of beta-HCG).

Progesterone Hormone in Luteal Phase Support

Injectable form of progesteroneis more effective but it is slightly painful due to needle injection… Oral progesterone is more convenient and easier to take on it doesn’t not involve injection.. However, it has to pass through first past hepatic effect and therefore this hormones will be metabolized; therefore it is not as affective as the intramuscular or vaginal route.

The most efficient and effective way is by using vaginal progesterone. Vaginal progesterone is inserted through the vagina. Due to the efficiency, convenient and no first past hepatic effect, vaginal progesterone is the treatment of choice for luteal phone support.

Figure 1

Figure 2

Figure 3 Examples of vaginal progesterone