Luteal phase support with gonadotropin-releasing hormone agonist.

Kung et al authored a valuable article entitled “Luteal phase support with decapeptyl improves pregnancy outcomes in ICSI with basal FSH >8 mIU/mL or mature oocytes 3”. This retrospective study enrolled 240 patients who underwent intracytoplasmic sperm injection (ICSI). One hundred and forty-seven patients were in the decapeptyl group and 93 patients were in the control group. The authors investigated the effect of decapeptyl as an additional luteal phase support (LPS) in in vitro fertilization (IVF) cycles and tested which subgroup would benefit from the treatment. We recognize the probity of this publication. Luteal phase defect is a common problem encountered during IVF cycles. In the past, several theories have been proposed such as (1) defective corpora lutea formed from the remnants of the aspirated follicles and (2) prolonged pituitary downregulation by the gonadotropin-releasing hormone (GnRH) agonist. Both of these theories attempt to explain premature luteolysis during IVF cycles; however, there has been a lack of subsequently published studies with sufficiently reliable evidence to support these theories. By contrast, a new hypothesis of multiple corpora lutea has been proposed. This hypothesis is based on the effect occurring after ovarian hyperstimulation wherein more steroids are subsequently produced, which suggests that the negative feedback on the pituitary gland inhibits luteinizing hormone release. Premature luteolysis arise from the negative feedback by high concentrations of steroids caused by multiple corpora lutea. However, there is no doubt that LPS is essential to enhance reproductive outcomes in IVF cycles. Progesterone and human chorionic gonadotropin have served as popular and effective LPS agents. In addition, Tesarik et al described using a GnRH agonist as LPS to improve the implantation rate, pregnancy rate, and live birth rate. Several studies subsequently support the results obtained by Tesarik et al, whereas other studies show dissimilar conclusions. Taken together, two systemic reviews, which include meta-analyses, demonstrate that administering a luteal phase single-dose GnRH agonist can significantly ameliorate IVF outcomes. Kung et al confirmed in their study the beneficial effect of luteal phase single-dose decapeptyl administration on the implantation rate (24.5% vs. 17.0%; p 1⁄4 0.023), clinical pregnancy rate (49.0% vs. 33.3%; p 1⁄4 0.023), and live birth rate (41.5% vs. 28.0%; p 1⁄4 0.039). The precise mechanism of how a GnRH agonist exerts its effect in the luteal phase remains unclear. Some studies