In Vitro Fertilization Process: Luteal Support

Without the presence of progesterone, early pregnancies result in miscarriage. This hormone is secreted by the dominant ovarian follicle(s) after ovulation occurs in response to luteinizing hormone (LH) or human chorionic gonadotropins (HCG).

It has become the standard of care to provide supplemental progesterone to patients in ART cycles either by giving progesterone directly or by stimulating the existing corpus luteum to secrete more progesterone by providing HCG.

Providing progesterone insures that the pregnancy receives an adequate supply of progesterone until the placenta takes over the support of the corpus luteum via HCG production. Progesterone must be given daily, whereas HCG can be given twice during the luteal phase.

Since progesterone is a dysphoric hormone, in some women there is a risk of it exacerbating symptoms of depression. In addition, human chorionic gonadotropins can exacerbate ovarian hyperstimulation symptoms and can cause a false positive pregnancy test if it is checked too soon.

Luteal support has been used at Duke for over 15 years as a method for improving fertility. The type of luteal support provided to a patient is determined by the patient’s physician based on the risks and benefits pertinent to each patient’s situation.