Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, P.O.B. 39040, 69978, Tel Aviv, Israel.
The IVF Clinic, 13/F Central Tower, 28 Queens Road Central, Hong Kong, China.
Reprod Biol Endocrinol. 2021 Jan 26;19(1):15. doi: 10.1186/s12958-021-00696-2.
It has been demonstrated that luteal phase support (LPS) is crucial in filling the gap between the disappearance of exogenously administered hCG for ovulation triggering and the initiation of secretion of endogenous hCG from the implanting conceptus. LPS has a pivotal role of in establishing and maintaining in vitro fertilization (IVF) pregnancies. Over the last decade, a plethora of studies bringing new information on many aspects of LPS have been published. Due to lack of consent between researchers and a dearth of robust evidence-based guidelines, we wanted to make the leap from the bench to the bedside, what are the common LPS practices in fresh IVF cycles compared to current evidence and guidelines? How has expert opinion changed over 10 years in light of recent literature?
Over a decade (2009-2019), we conducted 4 web-based surveys on a large IVF-specialist website on common LPS practices and controversies. The self-report, multiple-choice surveys quantified results by annual IVF cycles.
On average, 303 IVF units responded to each survey, representing, on average, 231,000 annual IVF cycles. Most respondents in 2019 initiated LPS on the day of, or the day after egg collection (48.7 % and 36.3 %, respectively). In 2018, 72 % of respondents administered LPS for 8-10 gestational weeks, while in 2019, 65 % continued LPS until 10-12 weeks. Vaginal progesterone is the predominant delivery route; its utilization rose from 64 % of cycles in 2009 to 74.1 % in 2019. Oral P use has remained negligible; a slight increase to 2.9 % in 2019 likely reflects dydrogesterone's introduction into practice. E2 and GnRH agonists are rarely used for LPS, as is hCG alone, limited by its associated risk of ovarian hyperstimulation syndrome (OHSS).
Our Assisted reproductive technology (ART)-community survey series gave us insights into physician views on using progesterone for LPS. Despite extensive research and numerous publications, evidence quality and recommendation levels are surprisingly low for most topics. Clinical guidelines use mostly low-quality evidence. There is no single accepted LPS protocol. Our study highlights the gaps between science and practice and the need for further LPS research, with an emphasis on treatment individualization.
黄体支持（LPS）对于填补外源性 hCG 诱发排卵和着床胚胎内源性 hCG 分泌之间的空白至关重要。LPS 在建立和维持体外受精（IVF）妊娠中起着关键作用。在过去的十年中，发表了大量关于 LPS 许多方面的新信息。由于研究人员之间缺乏共识和缺乏基于证据的强有力指南，我们希望从实验室走向临床，与当前的证据和指南相比，新鲜 IVF 周期中 LPS 的常见实践是什么？鉴于最近的文献，专家意见在过去 10 年中发生了怎样的变化？
在过去的十年（2009-2019 年）中，我们在一个大型 IVF 专家网站上进行了四项关于 LPS 常见实践和争议的网络调查。自我报告、多项选择题调查通过年度 IVF 周期量化结果。
平均而言，每项调查有 303 个 IVF 单位回复，平均代表 231,000 个年度 IVF 周期。2019 年，大多数受访者在取卵当天或取卵后一天开始 LPS（分别为 48.7%和 36.3%）。2018 年，72%的受访者给予 LPS 治疗 8-10 周，而 2019 年，65%的受访者继续 LPS 治疗至 10-12 周。阴道孕酮是主要的输送途径；其使用率从 2009 年的 64%上升到 2019 年的 74.1%。口服 P 的使用仍然微不足道；2019 年略有增加至 2.9%，可能反映出地屈孕酮在实践中的应用。E2 和 GnRH 激动剂很少用于 LPS，单独使用 hCG 也很少，这是由于其与卵巢过度刺激综合征（OHSS）相关的风险所限。
我们的辅助生殖技术（ART）社区调查系列让我们深入了解了医生对使用孕酮进行 LPS 的看法。尽管进行了广泛的研究和大量的出版物，但大多数主题的证据质量和推荐水平都令人惊讶地低。临床指南主要使用低质量的证据。没有一个单一的 LPS 协议被接受。我们的研究突出了科学与实践之间的差距，以及进一步进行 LPS 研究的必要性，重点是个体化治疗。
