A review on the A review on the luteal phase luteal phase P Devroey MD PhD P Devroey MD PhD Centre for Reproductive Medicine Centre for Reproductive Medicine Dutch-speaking Brussels Free University Dutch-speaking Brussels Free University Brussels - Belgium Brussels - Belgium
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A review on the luteal phase P Devroey MD PhD Centre for Reproductive Medicine Dutch-speaking Brussels Free University Brussels - Belgium.
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A review on the luteal A review on the luteal phasephase
P Devroey MD PhDP Devroey MD PhDCentre for Reproductive MedicineCentre for Reproductive Medicine
Dutch-speaking Brussels Free UniversityDutch-speaking Brussels Free University
Brussels - BelgiumBrussels - Belgium
Learning objectivesLearning objectives
• Is the luteal phase defective after ovulation Is the luteal phase defective after ovulation
induction in anovulatory women ?induction in anovulatory women ?
• Is the luteal phase defective after Is the luteal phase defective after
Is there any influence on endometrial Is there any influence on endometrial histology during the follicular phase in histology during the follicular phase in
gonadotrophin stimulated cycles before the gonadotrophin stimulated cycles before the injection of hCG ?injection of hCG ?
YESYES or or NONO
Is there any influence on endometrial Is there any influence on endometrial histology during the follicular phase in histology during the follicular phase in
gonadotrophin stimulated cycles before the gonadotrophin stimulated cycles before the injection of hCG ?injection of hCG ?
YESYES or or NONO
AnswerAnswer : : YesYes
100 % secretory advancement in preovulatory 100 % secretory advancement in preovulatory endometria ( pre - hCG ) during ovarian endometria ( pre - hCG ) during ovarian stimulation stimulation
( Marchini FS 1991 )( Marchini FS 1991 )
Is there any influence on endometrial Is there any influence on endometrial histology in agonist / gonadotrophin histology in agonist / gonadotrophin
stimulated cycles 36 hours after hCG stimulated cycles 36 hours after hCG administration ?administration ?
YESYES or or NONO
Is there any influence on endometrial Is there any influence on endometrial histology in agonist / gonadotrophin histology in agonist / gonadotrophin
stimulated cycles 36 hours after hCG stimulated cycles 36 hours after hCG administration ?administration ?
YESYES or or NONO
AnswerAnswer : : YesYes
100 % ( n = 40 patients )100 % ( n = 40 patients )
2 - 5 days advancement 2 - 5 days advancement ( Ubaldi FS 1997 )( Ubaldi FS 1997 )
Is there any influence on endometrial Is there any influence on endometrial histology in antagonist / gonadotrophin histology in antagonist / gonadotrophin
stimulated cycles ?stimulated cycles ?
YESYES or or NONO
Is there any influence on endometrial Is there any influence on endometrial histology in antagonist / gonadotrophin histology in antagonist / gonadotrophin
stimulated cycles ?stimulated cycles ?
YESYES or or NONO
AnswerAnswer : : YesYes
100 % ( n = 55 patients )100 % ( n = 55 patients )
2 - 4 days advancement 2 - 4 days advancement ( Kolibianakis FS 2002 )( Kolibianakis FS 2002 )
Endometrial biopsy on the day Endometrial biopsy on the day of ovulation , natural cycleof ovulation , natural cycle
No secretory featuresNo secretory features
Endometrial biopsy on the day of Endometrial biopsy on the day of oocyte retrieval , GnRH agonist and oocyte retrieval , GnRH agonist and
Endometrial advancement persists in Endometrial advancement persists in the midluteal phasethe midluteal phase
YESYES or or NONO
Patient
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Midluteal phase
Histological regression of endometrium from oocyte retrieval to the midluteal phase
Kolibianakis, Bourgain, Platteau, Albano, Van Steirteghem, Devroey F S 80 2003
Describe the LH concentration during the luteal Describe the LH concentration during the luteal phase ( post hCG ) in agonist gonadotrophin phase ( post hCG ) in agonist gonadotrophin
stimulated cyclesstimulated cycles
LOWLOW or or HIGHHIGH
Describe the LH concentration during the luteal Describe the LH concentration during the luteal phase ( post hCG ) in agonist gonadotrophin phase ( post hCG ) in agonist gonadotrophin
stimulated cyclesstimulated cycles
LOWLOW or or HIGHHIGH
AnswerAnswer : : LowLow
Smitz HR 1988Smitz HR 1988
Are the LH concentrations during the luteal phase Are the LH concentrations during the luteal phase ( post hCG ) in agonist - gonadotrophin stimulated ( post hCG ) in agonist - gonadotrophin stimulated
cycles similar to the LH concentrations in the cycles similar to the LH concentrations in the follicular phase ?follicular phase ?
YESYES or or NONO
Are the LH concentrations during the luteal phase Are the LH concentrations during the luteal phase ( post hCG ) in agonist - gonadotrophin stimulated ( post hCG ) in agonist - gonadotrophin stimulated
cycles similar to the LH concentrations in the cycles similar to the LH concentrations in the follicular phase ?follicular phase ?
AnswerAnswer : : NoNo
Demoulin FS 1991Demoulin FS 1991
Before hCGBefore hCG 1.5 mIU / ml1.5 mIU / ml
12 hours after hCG12 hours after hCG 0.5 mIU / ml0.5 mIU / ml
96 hours after hCG 96 hours after hCG 0.2 mIU / ml0.2 mIU / ml P < 0.0001P < 0.0001
WHY ?WHY ?
Is the luteal phase LH concentration ( post Is the luteal phase LH concentration ( post hCG ) in antagonist - gonadotrophin cycles hCG ) in antagonist - gonadotrophin cycles
normal or decreased ?normal or decreased ?
AnswerAnswer : : decreaseddecreased
Is the luteal phase LH concentration ( post Is the luteal phase LH concentration ( post hCG ) in antagonist - gonadotrophin cycles hCG ) in antagonist - gonadotrophin cycles
normal or decreased ?normal or decreased ?
Are the luteal phase concentrations Are the luteal phase concentrations ( post hCG ) similar in gonadotrophin alone ( post hCG ) similar in gonadotrophin alone versus antagonist gonadotrophin stimulated versus antagonist gonadotrophin stimulated
cycles ?cycles ?
YESYES or or NONO
Are the luteal phase concentrations Are the luteal phase concentrations ( post hCG ) similar in gonadotrophin alone ( post hCG ) similar in gonadotrophin alone versus antagonist gonadotrophin stimulated versus antagonist gonadotrophin stimulated
cycles ?cycles ?
YESYES or or NONO
AnswerAnswer : : YesYes
Tavaniotou HR Tavaniotou HR
20012001
Luteinizing hormone serum concentrations Luteinizing hormone serum concentrations in Clomid gonadotrophin antagonist or in Clomid gonadotrophin antagonist or
Is the luteal phase length normal after Is the luteal phase length normal after gonadotrophin stimulation in non IVF ?gonadotrophin stimulation in non IVF ?
YESYES or or NONO
Is the luteal phase length normal after Is the luteal phase length normal after gonadotrophin stimulation in non IVF ?gonadotrophin stimulation in non IVF ?
YESYES or or NONO
AnswerAnswer : : NoNo
Olson FS 1983Olson FS 1983
CyclesCycles 7878
Normal lengthNormal length 6060
ShortenedShortened 18 ( 23 % )18 ( 23 % )
StatementStatement : : GnRH antagonist can be safely GnRH antagonist can be safely
administered in gonadotrophin stimulated IUI administered in gonadotrophin stimulated IUI
cycles without luteal phase supplementationcycles without luteal phase supplementation
Ragni HR 2001Ragni HR 2001
Is the statement in contradiction with Is the statement in contradiction with the lecture ?the lecture ?
YESYES or or NONO
Is the statement in contradiction with Is the statement in contradiction with the lecture ?the lecture ?