Department of Gynecological Endocrinology and Reproductive Medicine, University Hospital of Schleswig-Holstein, Luebeck, Germany.
Division of Reproductive Endocrinology and Infertility, Department of Reproductive Medicine, University of California, San Diego, La Jolla, California.
Fertil Steril. 2018 May;109(5):747-748. doi: 10.1016/j.fertnstert.2018.02.009.
The increasing utilization of a gonadotropin-releasing hormone agonist ovulation trigger and the widespread use of artificial cycles for the transfer of frozen-thawed or donated embryos has renewed interest in the luteal phase in assisted reproductive technology. The "luteal phase defect" phenomenon is now understood as a continuum: there is less impairment with milder stimulation than with more intense ovarian stimulation, and less impairment after controlled ovarian stimulation and human chorionic gonadotropin ovulation triggering than after gonadotropin-releasing hormone agonist ovulation triggering, the latter being associated with rapid luteolysis. The intensity of the support of luteal phase necessary to achieve optimal outcomes therefore depends on the degree of luteal phase defect encountered in different treatment protocols. Ultimately, the luteal phase of an artificial cycle in which ovulation is suppressed, a corpus luteum is therefore absent, and the establishment of endometrial receptivity completely relies on the orchestrated exogenous administration of sex steroids, is the litmus test situation for the study of the efficacy of different luteal phase support preparations, doses, regimens, and routes of administration.
促性腺激素释放激素激动剂诱发排卵触发的应用增加和冷冻-解冻或捐赠胚胎的人工周期转移的广泛应用，使人们对辅助生殖技术中的黄体期重新产生了兴趣。“黄体期缺陷”现象现在被理解为一个连续体：与更强烈的卵巢刺激相比，轻度刺激的损害较小，与促性腺激素释放激素激动剂诱发排卵触发相比，控制性卵巢刺激和人绒毛膜促性腺激素诱发排卵触发后的损害较小，后者与快速黄体溶解有关。因此，实现最佳结果所需的黄体期支持的强度取决于不同治疗方案中遇到的黄体期缺陷的程度。最终，在抑制排卵的人工周期中，黄体期因此不存在，子宫内膜容受性的建立完全依赖于性激素的精心外源给药，这是研究不同黄体期支持制剂、剂量、方案和给药途径疗效的试金石情况。
