Pritts E A, Atwood A K
Department of Obstetrics and Gynecology, University of California, San Francisco, CA 94143, USA and University of Sydney School of Medicine, Sydney, Australia.
Hum Reprod. 2002 Sep;17(9):2287-99. doi: 10.1093/humrep/17.9.2287.
The addition of GnRH agonist to the treatment regimen in women undergoing IVF cycles is thought to create a luteal phase defect. In an attempt to correct for this, many practitioners supplement with a variety of steroid hormones in the luteal phase.
To determine whether luteal phase support increases reproductive success in modern IVF cycles, a systematic review of the literature was performed. Meta-analyses were conducted when multiple homogeneous studies addressed a single issue. Only randomized controlled trials were included in the data analysis. The efficacy of supplementation, as well as the optimal route, formulation, dose, and length of administration were queried.
Luteal supplementation with either i.m. hCG or i.m. progesterone significantly improved fertility outcomes compared with no treatment. When comparing i.m. progesterone with i.m. hCG, no fertility differences were found. Intramuscular progesterone conferred the most benefit compared with oral or vaginal use. Addition of oral estrogen to progesterone also improved implantation rates.
Given the increased risk of ovarian hyperstimulation syndrome associated with hCG use, i.m. progesterone is favoured for luteal phase supplementation with the addition of estrogen.
在接受体外受精（IVF）周期治疗的女性中，在治疗方案中添加促性腺激素释放激素（GnRH）激动剂被认为会导致黄体期缺陷。为了纠正这一问题，许多从业者在黄体期补充各种甾体激素。
为了确定黄体期支持是否能提高现代IVF周期的生殖成功率，对文献进行了系统综述。当多个同类研究涉及同一问题时，进行荟萃分析。数据分析仅纳入随机对照试验。研究了补充剂的疗效以及最佳途径、剂型、剂量和给药时长。
与不治疗相比，肌肉注射人绒毛膜促性腺激素（hCG）或肌肉注射黄体酮进行黄体期补充显著改善了生育结局。当比较肌肉注射黄体酮和肌肉注射hCG时，未发现生育差异。与口服或阴道使用相比，肌肉注射黄体酮带来的益处最大。在黄体酮中添加口服雌激素也提高了着床率。
鉴于使用hCG会增加卵巢过度刺激综合征的风险，肌肉注射黄体酮并添加雌激素更适合用于黄体期补充。
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