Luteal phase support after gonadotropin-releasing hormone agonist triggering: does it still matter?

Despite the increasing utilization of freeze-only IVF protocols, there is still a need for adequate management of the luteal phase after GnRH agonist trigger for patients who desire a fresh embryo transfer. Two approaches, intensive luteal support with E2 and P, and the use of adjuvant low-dose hCG either at the time of GnRH agonist trigger (dual trigger) or at the time of oocyte retrieval, have been shown to be effective in maintaining adequate pregnancy outcomes. The addition of low-dose hCG should be used with caution, because it may increase the risk of ovarian hyperstimulation syndrome. For patients with peak E2 of >4,000 pg/mL, we recommend against adding low-dose hCG, because intensive luteal support alone seems to provide adequate results.