Exogenous progesterone for LH surge prevention is redundant in ovarian stimulation protocols

During ovarian stimulation for IVF–embryo transfer treatment, a premature LH surge may lead to progesterone elevation that disrupts endometrial maturation and affects the probability of pregnancy following fresh embryo transfer. Preventing this LH surge and progesterone elevation using gonadotrophin...

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Bibliographic Details
Published in:Reproductive biomedicine online 2021-04, Vol.42 (4), p.694-697
Main Authors: Messinis, Ioannis E., Messini, Christina I., Anifandis, George, Daponte, Alexandros
Format: Article
Language:English
Subjects:
Freeze-all
Fresh embryo transfer
GnRH antagonists
IVF
Progesterone
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Summary:During ovarian stimulation for IVF–embryo transfer treatment, a premature LH surge may lead to progesterone elevation that disrupts endometrial maturation and affects the probability of pregnancy following fresh embryo transfer. Preventing this LH surge and progesterone elevation using gonadotrophin-releasing hormone (GnRH) analogues is considered a standard practice. The same policy applies to cycles in which the ‘freeze-all’ protocol has been selected from the outset (e.g. donors), but the need for this has not been discussed. Moreover, in ‘freeze-all’ cycles, exogenous progesterone administration tends to replace GnRH antagonists, without reducing efficacy after embryo transfer in frozen-thawed cycles. Nevertheless, as exogenous progesterone is expected to have the same impact on the endometrium as endogenous progesterone, it is clear that, unlike in fresh cycles, in ‘freeze-all’ cycles an endogenous LH surge prevention does not seem necessary. Therefore, both GnRH antagonists and exogenous progesterone appear to be redundant in ‘freeze-all’ cycles, and in this context the indications for the use of GnRH analogues in ovarian stimulation protocols need to be revisited.
ISSN:1472-6483
1472-6491
DOI:10.1016/j.rbmo.2021.01.017