Luteal support in reproduction

1.0 CME/CE Credits

Symposium held November 2008 at the American Society for Reproductive Medicine Annual Meeting in San Francisco, California. Supported by an independent educational grant from Columbia Laboratories.

	Sandra A. Carson, MD (moderator) Editor, Sexuality, Reproduction & Menopause, Professor of Obstetrics and Gynecology, Alpert Medical School of Brown University, Director, Division of Reproductive Endocrinology and Infertility, Women & Infants Hospital of Rhode Island, Providence, Rhode Island	A supplement containing information from this symposium appeared in the May 2009 issue of SRM.
	Valerie L. Baker, MD Medical Director, Stanford Fertility & Reproductive Medicine Center, Stanford, California
	James H. Liu, MD Arthur H. Bill Professor and Chair, Departments of Reproductive Biology and Obstetrics & Gynecology, Case Western Reserve Medical School, University Hospitals Case Medical Center, Cleveland, Ohio

DEFINING OUR TERMS

In this panel discussion, reproductive medicine specialists Valerie L. Baker, MD, James H. Liu, MD, and Sandra A. Carson, MD (as moderator), cover practical issues in luteal support in reproduction:

• To prevent recurrent miscarriage
• To treat polycystic ovary syndrome
• To support pregnancy in assisted reproduction

For the most part, the focus is on progestogens, a class of hormones whose main purpose is to support gestation. Progesterone is the major naturally occurring progestogen. And the progestins are synthetically produced progestogens not found in nature.

NEEDS ASSESSMENT

Progesterone is essential to prepare the uterine endometrium for implantation and to maintain pregnancy. It converts the proliferative endometrium to the secretory endometrium, maintaining the uterine glands. Progesterone also maintains the uterine myometrium in a quiescent state during pregnancy, preventing contractions and expulsion of the fetus. Furthermore, progesterone prevents endometrial hyperplasia in the face of elevated levels of estrogens. Thus, progesterone supplementation has come to be used widely to prevent recurrent miscarriage and preterm birth; to reduce implantation failure in assisted reproductive technologies; to prevent endometrial hyperplasia in women with secondary amenorrhea due to metabolic syndrome; and as a component of combined hormone therapy for menopausal women.

According to the Practice Committee of the American Society for Reproductive Medicine, however, “progesterone supplementation necessarily is empiric and has been applied liberally in clinical circumstances wherein the amount or duration of P production is reasonably suspect.” Data are conflicting as to whether progesterone supplementation associated with assisted reproductive technologies is necessary or even beneficial. Nonetheless, hundreds of websites promote the use of progesterone. One even claims that “All women free of medical complication can benefit from progesterone supplementation”. Physicians as well as patients are confused about the clinical utility of progestogens and also about the dosage, duration and type of progestogen to use in particular situations. For this reason, the ASRM issued a report addressing the evidence-based uses of progestogens and the risks associated with progestogen administration. The goal of this symposium is to provide physicians and nurses in reproductive medicine and gynecology with current perspectives on the use of progestogens in assisted reproductive technologies, in the treatment of secondary amenorrhea, in postmenopausal hormone therapy and in recurrent pregnancy loss.

LEARNING OBJECTIVES
At the conclusion of this symposium, participants should be able to:

1. Discuss the effects that progestins and progesterone have on the endometrium.
2. Identify differences among synthetic progestins and progesterone with regard to differences in side-effect profiles.
3. Compare and contrast routes of progestogen administration and resulting differences in efficacy.
4. Discuss with patients the risk/benefit profiles in recommending hormone therapy.

READ THE SUPPLEMENT | FULL TEXT

Click here to take the CME pretest

Click here to take the FREE CME/CE test online.

1.0 CME/CE credit available
Expiration date: May 5, 2010

All speakers were required to complete a disclosure of commercial and financial relationships with manufacturers of pharmaceuticals, laboratory supplies, or medical devices and with commercial providers of medically related services. These disclosures were reviewed and potential conflicts of interest resolved by the Subcommittee on Standards of Commercial Support of the Continuing Medical Education Committee of the American Society for Reproductive Medicine. The disclosures are listed in the presentations.

Sponsored by the Association for Reproductive Medicine.

Supported by an educational grant from Columbia Laboratories.