Grazi, R. V., Taney, F. H., Gagliardi, C. L., Von Hagen, S., Weiss, G., & Schmidt, C. L. (1991). The luteal phase during gonadotropin therapy: effects of two human chorionic gonadotropin regimens. Fertility and Sterility, 55(6), 1088-1092. https://doi.org/10.1016/s0015-0282(16)54357-x
Grazi RV, Taney FH, Gagliardi CL, Von Hagen S, Weiss G, Schmidt CL. The luteal phase during gonadotropin therapy: effects of two human chorionic gonadotropin regimens. Fertil Steril. 1991;55(6):1088-1092. doi:10.1016/s0015-0282(16)54357-x
Grazi, Richard V., et al. "The luteal phase during gonadotropin therapy: effects of two human chorionic gonadotropin regimens." Fertility and Sterility, vol. 55, no. 6, 1991, pp. 1088-1092.
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A second hCG injection lengthened the luteal phase in hMG cycles
A randomized within-woman comparison in 15 women who did not ovulate or had luteal phase defects found that a second hCG injection lengthened the luteal phase after hMG stimulation. The median luteal phase lasted 16 days with two injections and 11 days with one.
Key Findings
Fifteen women completed both arms. Each had two nonconception cycles of human menopausal gonadotropin (hMG) stimulation, with human chorionic gonadotropin (hCG) given as one injection or as two divided injections.
Median luteal phase length was 16 days (interquartile range 15 to 17) with the split regimen and 11 days (interquartile range 10 to 12) with the single injection (P < 0.05).
Four of 15 women (27%) had short luteal phases with the single injection. No woman had a short luteal phase with the split regimen.
Late luteal estradiol and progesterone levels were significantly higher with the split regimen (P < 0.05). Early and midluteal levels were similar between the two regimens.
Follicular phase length, peak preovulatory estradiol and the number of mature follicles did not differ significantly between regimens, and luteinized unruptured follicle syndrome occurred in no woman.
Interpretation
This randomized, within-woman crossover study assigned each woman's first regimen by sealed envelope, then compared hormone levels and luteal phase length across her two hMG cycles. The authors note that luteal phase length was the only measure of luteal adequacy used in this analysis. The findings support larger studies of split hCG dosing in women undergoing ovarian stimulation.
RRM Context
Cycle charting records how long the phase after ovulation lasts. Restorative reproductive medicine counts a sound luteal phase as part of a healthy ovulatory cycle. The corpus luteum, the structure that makes progesterone after ovulation, is part of that evaluation. The authors suggest that luteal defects may partly explain the gap between ovulation and conception after ovarian stimulation.
Our editorial summary of this paper, not the article's abstract.
Abstract
Objective
Luteal phase abnormalities are known to complicate ovulation induction with gonadotropins. This study was performed to test the effect of a modified human chorionic gonadotropin (hCG) regimen on the luteal phase during gonadotropin treatment.
Design
Fifteen women from a private practice setting volunteered to be studied during each of two nonconception, gonadotropin-stimulated cycles. After ovarian stimulation with human menopausal gonadotropins (hMG), hCG was administered either as a single dose of 10,000 IU (single dose) or in two divided doses of 5,000 IU given 1 week apart (split dose).
Main Outcome Measures
Early, midluteal, and late luteal estradiol (E2) and progesterone (P) levels and luteal phase lengths were measured, and their median values and intraquartile ranges (IQR) compared using nonparametric analysis.
Results
Early and midluteal E2 and P levels were similar regardless of which hCG regimen was administered. The median late luteal E2 level was 1,146.0 pg/mL (the IQR ranged from 633 to 1,650, IQR = 1,017) with the split-dose regimen and 240.0 pg/mL (the IQR ranged from 150 to 460, IQR = 310) with the single-dose regimen. The median late luteal P level was 108.0 ng/mL (the IQR ranged from 58.5 to 129, IQR = 70.5) with the split-dose regimen and 4.2 ng/mL (the IQR ranged from 1.9 to 11.7, IQR = 9.8) with the single-dose regimen. Median luteal phase lengths were 16 days (the IQR ranged from 15 to 17, IQR = 2) for the split-dose regimen and 11 days (the IQR ranged from 10 to 12, IQR = 2) for the single-dose regimen.
Conclusion
In hMG-stimulated cycles, a second dose of hCG given during the midluteal phase significantly increases late luteal E2 and P levels and consistently lengthens the luteal phase.
