Luteal Support
Luteal Support (Hormone supplements)
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 assisted reproductive technology (ART) cycles, either by giving progesterone directly or by stimulating the existing corpus luteum to secrete more progesterone by providing intramuscular HCG.
There are several forms of progesterone hormone supplements available, including vaginal suppositories, and injection progesterone. Injection progesterone and suppositories are usually dosed as 25 to 50 mg twice daily.
Providing progesterone hormone supplements insures that the pregnancy receives an adequate supply of the hormone until the placenta takes over the support of the corpus luteum via HCG production. Progesterone must be given daily, whereas intramuscular 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, intramuscular HCG can exacerbate ovarian hyperstimulation symptoms and can cause a false positive pregnancy test if it is checked too soon.
Luteal support in the form of hormone supplements 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.
Crinone
Crinone is a form of progesterone that is administered in the vagina as a gel. This takes the place of supplemental HCG, progesterone suppositories, and progesterone in oil.
Crinone 8 percent at bedtime is usually continued to seven weeks, when used to replace supplemental HCG in patients at risk for hyperstimulation, and twice daily until 10 weeks when used with “programmed cycles” (oocyte recipients and frozen embryo transfers).
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