Is There Clinical Value in the Mid-Luteal Progesterone Check in Same-Sex Female Couples Undergoing Donor Sperm Intrauterine Insemination?

Abstract

Purpose: The objective was to evaluate whether the mid-luteal progesterone (MLP) assessment in same-sex female couples benefits clinical outcomes in natural cycles using donor sperm intrauterine insemination (IUI).
Methods: This retrospective cohort study included same-sex female couples undergoing donor sperm IUI from January 2004 to April 2022. Cases included patients with MLP evaluation; controls included those without. MLP was obtained ∼7 days after ovulation. Only natural cycles with human chorionic gonadotropin trigger for timing were included. Primary outcome was clinical pregnancy rate; secondary outcomes were ongoing pregnancy (OP) and spontaneous abortion rates.
Results: The study included 912 cycles, in 56 of which MLP was assessed. There were no demographic differences between groups. Among those assessed, the mean MLP was 10.96 ng/mL and 19/56 (33.9%) subsequently received supplemental progesterone. In an unadjusted analysis, there were no significant differences in clinical outcomes between groups. After adjusting for age, body mass index, day 3 follicle-stimulating hormone, and endometrial thickness at the time of ovulation, having MLP evaluated did not predict clinical (odds ratio [OR]: 3.34, confidence interval [CI]: 0.194–57.510, p = 0.406) or OP rate (OR 5.056, CI 0.24–106.62, p = 0.298). A subanalysis found no difference in clinical and OP rates when comparing patients who had received supplemental progesterone versus those who had not.
Conclusion: Clinicians may reconsider the MLP assessment within same-sex female couples who use donor sperm IUI, as it does not appear to enhance treatment outcome. Prospective studies may delineate the cost–benefit analysis of the MLP assessment in this cohort.

Full text

ORIGINAL ARTICLE Open Access
Is There Clinical Value in the Mid-Luteal Progesterone
Check in Same-Sex Female Couples Undergoing Donor
Sperm Intrauterine Insemination?
Isabelle C. Band,
1,
*Samantha L. Estevez,
1,2
Joseph A. Lee,
2
Morgan Baird,
2
Noah Copperman,
2
Daniel Stein,
1,2
Tanmoy Mukherjee,
1,2
Alan B. Copperman,
1,2
and Jenna Friedenthal
1,2
Abstract
Purpose: The objective was to evaluate whether the mid-luteal progesterone (MLP) assessment in same-sex
female couples benefits clinical outcomes in natural cycles using donor sperm intrauterine insemination (IUI).
Methods: This retrospective cohort study included same-sex female couples undergoing donor sperm IUI from
January 2004 to April 2022. Cases included patients with MLP evaluation; controls included those without. MLP
was obtained *7 days after ovulation. Only natural cycles with human chorionic gonadotropin trigger for tim-
ing were included. Primary outcome was clinical pregnancy rate; secondary outcomes were ongoing pregnancy
(OP) and spontaneous abortion rates.
Results: The study included 912 cycles, in 56 of which MLP was assessed. There were no demographic differ-
ences between groups. Among those assessed, the mean MLP was 10.96 ng/mL and 19/56 (33.9%) subse-
quently received supplemental progesterone. In an unadjusted analysis, there were no significant differences
in clinical outcomes between groups. After adjusting for age, body mass index, day 3 follicle-stimulating hor-
mone, and endometrial thickness at the time of ovulation, having MLP evaluated did not predict clinical
(odds ratio [OR]: 3.34, confidence interval [CI]: 0.194–57.510, p=0.406) or OP rate (OR 5.056, CI 0.24–106.62,
p=0.298). A subanalysis found no difference in clinical and OP rates when comparing patients who had
received supplemental progesterone versus those who had not.
Conclusion: Clinicians may reconsider the MLP assessment within same-sex female couples who use donor sperm
IUI, as it does not appear to enhance treatment outcome. Prospective studies may delineate the cost–benefit
analysis of the MLP assessment in this cohort.
Keywords: mid-luteal progesterone; same-sex female couples; intrauterine insemination; medicalization;
lesbian
1
Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
2
Reproductive Medicine Associates of New York, New York, New York, USA.
Some data were previously presented as an oral abstract at the American Society for Reproductive Medicine 76th Scientific Congress & Expo held virtually from October
17 to 21, 2020.
*Address correspondence to: Isabelle C. Band, BA, Icahn School of Medicine at Mount Sinai, Department of Obstetrics, Gynecology, and Reproductive Science, 1176 Fifth
Avenue, 9th Floor, New York, NY 10029, USA, E-mail: isabelle.band@icahn.mssm.edu
ªThe Author(s) 2024. Published by Mary Ann Liebert, Inc. This Open Access article is distributed under the terms of the Creative Commons License
[CC-BY] (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the
original work is properly cited.
965
Women’s Health Reports
Volume 5.1, 2024
DOI: 10.1089/whr.2024.0056
Accepted September 17, 2024
Open camera or QR reader and
scan code to access this article
and other resources online.

Introduction
Heterosexual couples typically present for fertility
treatment due to “medical infertility,”which is defined
as the inability to conceive after 1 year or longer of
unprotected sex.
1
Same-sex female couples can experi-
ence “medical infertility,”yet most seek fertility care
out of the need to access donor sperm, which is com-
monly referred to as “social infertility.”
2
One could
hypothesize that same-sex female couples would have
similar or even higher pregnancy rates compared with
heterosexual couples seeking infertility treatment.
3
There are limited data on specific considerations for
same-sex female couples using assisted reproductive
technologies.
4,5
As a result, there is ongoing debate about
how to tailor clinical protocols for this population (i.e.,
whether to do natural intrauterine insemination [IUI]
timed to luteinizing hormone surge or use oral med-
ications or injectable gonadotropins for ovulation
induction [OI]).
4
Providers often use the same clinical
assessments within same-sex female couples without
diagnoses of medical infertility that are routinely used
in heterosexual couples experiencing medical infertil-
ity. As a result, same-sex female couples are frequently
subjected to costly, time-consuming, or invasive test-
ing and procedures that are not evidence-based within
the socially infertile patient population. For instance,
the mid-luteal progesterone (MLP) assessment is a
serum evaluation of a patient’s progesterone levels
sevendaysafterovulationtoconfirm ovulation has
occurred.
2
Although the MLP assessment may be
useful for indicating ovulation in medically infertile
heterosexual couples, it is not widely understood
whether the assessment is clinically valuable within
same-sex female couples.
6
Adequate luteal phase production of progesterone is
needed to induce endometrial changes required for
successful implantation of an embryo.
7
An MLP con-
centration of 4 ng/mL or greater typically indicates
ovulation; however, the clinical value of assessing MLP
levels has been widely disputed.
6–8
The American Soci-
ety for Reproductive Medicine does not have guidelines
regarding the value of the MLP assessment but has
noted that luteal phase deficiency—a clinical diagnosis
potentially caused by inadequate progesterone duration
or levels that is associated with an abnormal luteal
phase length £10 days—is not proven to independently
cause infertility or recurrent pregnancy loss.
9
A number of studies have presented mixed results
about the relationship between MLP concentrations
and pregnancy outcomes in patients undergoing OI,
OI followed by IUI (OI-IUI), IUI without exogenous
hormones, and in vitro fertilization (IVF).
8,10–18
While
some studies have demonstrated a significant relation-
ship between MLP levels, pregnancy, and live birth
rates, others have found that MLP levels do not
enhance treatment outcomes.
8,10–18
Research evaluating the clinical significance of MLP
has thus far focused on infertile heterosexual couples;
however, there is a paucity of data evaluating the utility
of MLP in same-sex female couples.
19
Therefore, our
objective was to determine whether there is an associa-
tion between MLP levels and clinical outcomes in
same-sex female couples undergoing donor sperm IUI
(dsIUI).
Materials and Methods
This single-center, retrospective study included all
same-sex female couples from 25 to 44 years of age
who underwent human chorionic gonadotropin (hCG)-
triggered natural cycle dsIUI at an academic, private fer-
tility practice between January 2004, when the center
began using an electronic medical record, and April
2022. Same-sex female couples who pursued dsIUI were
identified in an electronic medical record database and
included in the study. Cases included all patients who
had an evaluation of MLP. Controls included all
patients without MLP testing. Only hCG-triggered
natural cycles were included; medicated cycles for
OI or super ovulation were excluded. This study was
approved by Mount Sinai’s Institutional Review Board
with a waiver of patient consent (STUDY-18-00441).
Patient selection
Women who self-identified as “lesbian”or as a “same-
sex couple”were identified through natural language
processing of electronic medical records and were
included in the study. Women who had a known male
partner in the database, who identified as “single,”a
“single mother by choice,”or those who indicated a
desire for “single parenting”were excluded from the
analysis. In cases where a patient’s familial status
(e.g., “single”or “in a same-sex couple”)wasnotrecorded
anywhere in the electronic record, the patient was excl-
uded from analysis.
Total group protocol
Cycles followed one of two of the following protocols.
In the first protocol, patients undergoing natural cycle
preparation for IUI were monitored for the presence
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of a dominant follicle. On day 12, patients presented
for a follicle evaluation with transvaginal ultrasound.
Once a dominant follicle (‡18 mm) was observed,
ovulation was triggered with 250 mg of recombinant
hCG (Ovidrel; EMD Serono, Inc., Rockland, MA).
Endometrial thickness (EnT) was also recorded at this
cycletimepoint.dsIUIwasperformed36hoursafter
hCG administration. If preferred, patients were assigned
to a second protocol, in which patients utilized daily
ovulation predictor kits (OPK). When the OPK yie-
lded a positive result indicating ovulation, patients pre-
sented to the clinic that same day for dsIUI. Given
these protocols, MLP was defined as a progesterone
level obtained seven days after either the ovulation
trigger or first positive OPK.
Of note, select patients received supplemental pro-
gesterone, either in oral or in vaginal formulation, as
luteal phase support. For the patients who received
supplemental progesterone, the median MLP was
7.04 –4.61 ng/mL (range: 2.5–24.6 ng/mL). Those who
did not receive supplemental progesterone had a
higher median MLP (13.10 –4.60 ng/mL) with a range
of 0.16–25.1 ng/mL. On average, patients with an MLP
of <7 ng/mL received supplemental progesterone, but
patient clinical characteristics (e.g., past successful
pregnancy with use of progesterone supplementation)
also contributed to decision making.
Intrauterine insemination
As referenced in Nazem et al., previously cryopre-
served sperm samples were thawed in a 37C incuba-
tor for 15 minutes on the morning of the scheduled
dsIUI.
20
Samples were then thoroughly homogenized
with a large volume pipette. The volume of the sample
and spermatozoa count were recorded. Sperm wash
(Irvine Scientific, Santa Ana, CA) was then added to
twice the volume of the sample, and the sample was
mixed. The sample was centrifuged at 300 times grav-
ity, *1500 revolutions per minute for 10 minutes.
The supernatant was removed, and the pellet was
resuspended in 0.3 mL of sperm wash media and
mixed.
Outcome measures
Baseline patient characteristics and demographic data
were obtained, including age, body mass index (BMI),
anti-M€
ullerian hormone (AMH) level, day 3 follicle-
stimulating hormone (D3FSH) level, gravidity, parity,
and EnT at time of ovulation.
The primary study outcome was clinical pregnancy
(CP) rate, which was determined by the presence of a
gestational sac visualized on transvaginal ultrasound
*7–10 days following a positive serum b-hCG. Sec-
ondary outcomes included ongoing pregnancy (OP)
and spontaneous abortion rate. An OP was defined as
a viable intrauterine gestation at the time of discharge
from the practice, which was no earlier than 8 weeks
of gestation. A spontaneous abortion was considered
a loss after a visualized intrauterine gestational sac on
transvaginal ultrasound.
Statistical analyses
Statistical analyses were performed using SAS version
9.4 (SAS Institute Inc., Cary, NC). Continuous data
were reported as mean –standard deviation or
median (interquartile range) as appropriate. Compar-
ative statistics were performed using chi-square tests
for categorical data and either the Student’st-test or
Mann–Whitney Utest for continuous data. To assess
differences in clinical outcomes and adjust for poten-
tial confounders, a multivariable logistic regression
was performed for each outcome. Likelihood of clini-
cal outcomes was presented as odds ratios (OR) with
95% confidence intervals (CIs). In addition, a subanaly-
sis was performed evaluating the impact of progeste-
rone supplementation on the aforementioned outcomes.
All p-values were two sided with a clinical significance
level determined at p<0.05.
Results
A total of 912 hCG-triggered natural dsIUI cycles com-
pleted by 364 unique same-sex female couples were
included in the study. If a couple underwent >1cycleat
the center, all cycles that fit inclusion criteria were
included. In 56 cycles, which included 24 distinct
patients, the MLP assessment was performed. The
median MLP level was 7.04 –4.71 ng/mL. The decision
to assess MLP was based on individual provider or
patient preference (e.g., in cases where the patient had
had an MLP assessment in a prior cycle where they con-
ceived). Progesterone was supplemented in 19 of 56
cycles involving 14 unique patients. In the remaining
37 cycles including 31 unique patients, the median MLP
was 10 –4.60 ng/mL, and progesterone was not supple-
mented (p<0.001). Progesterone was not supplemented
in any of the cycles where MLP was not assessed.
Demographic and cycle characteristics of the patients
are included in Table 1. There were no statistically
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significant differences between patients who underwent
MLP assessment and those who did not with respect to
age, BMI, AMH, D3FSH, EnT at time of ovulation, and
gravidity (Table 1). The only significant difference
between the two groups was parity: patients who under-
went an MLP evaluation had significantly higher parity
compared to those who did not (p=0.0067), though
the majority of patients in both groups had a parity of
zero (85.71% in the MLP group vs. 91.25% in the no
MLPgroup).ThemeanMLPinthoseassessedwas
10.96 ng/mL.
In an unadjusted analysis, there were no significant
differences in clinical outcomes, including CP rate
(p=0.72), OP rate (p=0.72), and spontaneous abor-
tion rate (p=0.19), between the two groups (Table 2).
After adjusting for age, BMI, D3FSH, and EnT at time
of ovulation with logistic regression, the presence of
the MLP evaluation was not associated with CP rate
(OR 3.34, CI 0.19–57.51, p=0.41) or OP rate (OR
5.06, CI 0.24–106.62, p=0.30) (Table 3).
A subanalysis was performed to assess whether the
supplementation of progesterone influenced clinical
outcomes (Table 4). No significant differences in CP
and OP were found when comparing patients who
had received supplemental progesterone versus those
who had not.
Discussion
This study evaluated whether the assessment of MLP
levels in same-sex female couples influences pregnancy-
related outcomes in hCG triggered natural cycles using
dsIUI. In both adjusted and unadjusted analyses, there
were no significant differences in clinical outcomes
between patients who had versus those who did not
have MLP evaluation. Having MLP evaluated did not
appear to be associated with the odds of implantation,
Table 1. Demographic and Cycle Characteristics of Same-Sex Female Couples Undergoing Human Chorionic
Gonadotropin-Triggered Natural Cycles Using Donor Sperm Intrauterine Insemination
MLP (n556) No MLP (n5856) p-Value
Age (years)
Mean –SD
35.50 –3.48 35.42 –3.69 0.88
BMI
Median –IQR
23.59 –6.51 24.41 –6.58 0.69
AMH
Median –IQR
2.20 –1.55 2.92 –3.37 0.15
D3FSH
Median –IQR
7.16 –2.99 6.6 –2.4 0.24
EnT at time of ovulation
Median –IQR
9–29–2 0.83
Gravidity n (%) 0.97
0 23 (85.19) 259 (80.94)
1 2 (7.41) 30 (9.38)
>1 2 (7.41) 31 (9.69)
Parity n (%) 0.0067
0 24 (85.71) 292 (91.25)
1 3 (10.71) 24 (7.5)
>1 1 (3.51) 4 (1.25)
Luteal progesterone supplementation n (%) 19 (33.93) 0 (0) <0.001
Bolded p-value denotes statistical significance (p<0.05).
AMH, anti-M€
ullerian hormone; BMI, body mass index; D3FSH, day 3 follicle-stimulating hormone; EnT, endometrial thickness; IQR, interquartile
range; MLP, mid-luteal progesterone; SD, standard deviation.
Table 2: Pregnancy Outcomes of Same-Sex Couples Undergoing Human Chorionic Gonadotropin-Triggered Natural
Cycles Using Donor Sperm Intrauterine Insemination (Unadjusted)
MLP (n556) frequency (%) No MLP (n5856) frequency (%) p-Value
Clinical pregnancy 9/10
a
(90) 117/136
a
(86.03) 0.72
Ongoing pregnancy 9/9
b
(100) 98/117
b
(83.76) 0.72
Spontaneous abortion 0/9
b
(0) 19/117
b
(16.24) 0.19
a
Denominator is the number of patients who achieved biochemical pregnancy.
b
Denominator is the number of patients who achieved clinical pregnancy.
MLP, mid-luteal progesterone.
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OP,orspontaneousabortion.However,giventhesmall
number of cycles (n=56) in which the MLP assessment
was performed, the study lacked power to determine a
definitive difference in outcomes between the two
groups. Nevertheless, this study suggests no compelling
justification for performing the MLP assessment in
apatientwithoutaspecific indication and without med-
ical infertility. Hence, our results suggest foregoing
MLP testing except when specifically indicated or until
evidence is generated to support its use in same-sex
female couples.
Studies have presented mixed findings regarding
the relationship between MLP levels and pregnancy-
related outcomes in OI, IUI, and IVF.
8,10–18
Only
two of these studies investigated the clinical value of
the MLP assessment in patients undergoing natural
IUI cycles specifically. Fukuda et al. found that lower
MLP levels were associated with a higher pregnancy
rate in the subsequent IUI treatment cycle, especially
when ovulation occurred in the same ovary for two
consecutive cycles.
21
Those findings suggest that
mid-luteal hormone profiles may impact whether con-
ception will occur in the following menstrual cycle.
Takaya et al. demonstrated a positive association
between high MLP concentrations and cycles that
achieved a pregnancy in patients utilizing IUI without
human menopausal gonadotropin stimulation or
timed intercourse.
22
With regard to luteal phase progesterone supplemen-
tation, existing research has focused on OI-IUI rather
than hCG-triggered natural cycles using dsIUI.
23–34
A
2017 meta-analysis found that luteal phase support
improved CP and live birth rates in patients under-
going OI using injectable gonadotropins but not with
either clomiphene citrate alone or clomiphene citrate
plus injectable gonadotropins.
23
In our subanalysis,
this study found no significant differences in clinical
outcomes between those who received versus did not
receive supplemental progesterone. However, the sub-
analysis included 56 cycles (in 19 of which progester-
one supplementation was performed) and did not
reach power to detect a difference between groups.
Even though the use of assisted reproductive technol-
ogy (ART) is significantly increasing among same-sex
female couples, there is a paucity of data evaluating the
utility of tests and interventions specifically in this
patient population. Data of this nature would be ger-
mane to generating evidence-based, personalized infer-
tility treatment protocols for same-sex female couples.
This is the first study to investigate the clinical signifi-
cance of the MLP assessment in same-sex female cou-
ples undergoing hCG-triggered natural cycle dsIUI.
23
The study findings suggest that clinicians should
reconsider the MLP evaluation within same-sex female
couples who utilize dsIUI. Our findings showed MLP
assessment does not appear to enhance treatment out-
comes in same-sex female couples.
The evaluation of MLP could represent an example
of over-medicalization in the same-sex female couple
patient population. Medicalization is the process by
which human conditions and problems become defined
and treated as medical conditions. Medicalization can
not only be stigmatizing but it can also subject patients
to unnecessary, costly, time-consuming, and invasive
testing and procedures. An Australian study found that
clinical protocols that do not differ between women
with and without male partners were seen by clinicians
as responsible practice.
2
However, providers should be
cognizant of patients such as single women and women
in same-sex relationships who are seeking fertility treat-
ment due to social infertility. Socially infertile patients
may, but often do not, have concomitant medical infer-
tility and therefore likely require significantly less testing
and intervention. Fertility treatment for socially infertile
women should be personalized and distinct from
Table 3. Pregnancy Outcomes of Same-Sex
Couples (Adjusted)
OR 95% CI p-Value
Clinical pregnancy 3.34 0.19–57.51 0.41
Ongoing pregnancy 5.06 0.24–106.62 0.30
CI, confidence interval; OR, odds ratio.
Table 4. Supplemental Luteal Progesterone in Same-Sex Couples Undergoing Human Chorionic Gonadotropin-
Triggered Natural Cycles Using Donor Sperm Intrauterine Insemination
MLP with suppl. prog.(n519) n (%) MLP without suppl. prog. (n537) n (%) p-Value
Clinical pregnancy 3 (15.79) 6 (16.22) 0.967
Ongoing pregnancy 3 (15.79) 6 (16.22) 0.967
Spontaneous abortion 0 (0) 0 (0) n/a
Suppl. Prog.: supplemental progesterone.
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treatment for women with a medical infertility diagno-
sis. Although the MLP assessment is not a particularly
costly intervention, it is time consuming without pro-
viding clinical value in same-sex female couples under-
going dsIUI. Practitioners might consider reexamining
the tests and interventions that they utilize in this
patient population rather than adopting a “one-size-
fits-all”approach to patients seeking assisted reproduc-
tion. Personalized treatment for all patients will allow
providers to offer the best possible care while avoiding
unnecessary treatment.
Study strengths and limitations
This study had several strengths. Our study was per-
formed at a single, high-volume academic medical
center. This reduces the inherent variability around
protocols and management that may arise from mul-
ticenter studies. Study participants received relatively
uniform management due to the streamlined proto-
cols at the single study center. In addition, this study
was conducted in New York State, where same-sex
marriage was legalized in 2011.
35
Subsequently, in
2021, New York State began requiring that private
insurers cover services for the diagnosis and treatment
of infertility for those unable to conceive due to their
sexual orientation or gender identity.
36
Therefore, this
study was conducted in an environment that is ame-
nable and safe for same-sex female couples to grow
their families.
The study is not without its limitations. For one, it
was calculated that in order to have 80% power, we
would need 199 patients per group to detect a 10%
difference in pregnancy rate. As we did not have a
sufficient number of patients with MLP, this study
was underpowered. Therefore, we were unable to
draw a decisive conclusion regarding the utility of the
MLP assessment in same-sex female couples. A study
with a larger sample size of patients who received the
MLP assessment may be able to generate this evi-
dence; however, there is no compelling argument for
the clinical utility of performing the MLP assessment
in a patient without medical infertility or a specific
indication for the test. Another limitation was the
study’s retrospective design. To overcome this limita-
tion, an adjusted multivariable logistic regression
analysis was performed to minimize selection bias.
In addition, a third of the patients who underwent
the MLP assessment and were found to have an MLP
level of <7 ng/mL on average received supplemental
progesterone. The MLP levels of the patients who
were supplemented ranged from 2.5 to 24.6 ng/mL,
illustrating that patient characteristics (e.g., past suc-
cessful pregnancy with progesterone supplementa-
tion) as well as provider judgment impact clinical
decision making. To account for the fact that the infor-
mation obtained from the MLP assessment informed
subsequent clinical decision making, we performed a
subanalysis to compare patients who had received sup-
plemental progesterone with those who had not. The
subanalysis found no differences in terms of clinical
outcomes between the two groups. It should also be
noted that data regarding the time interval between
the prior delivery date and date of presentation to the
fertility center were not available.
Future directions
Large, prospective, multicenter studies could further
delineate the risk–benefit analysis of MLP assessment
in same-sex female couples undergoing natural cycle
dsIUI. The generation of more robust datasets will
help providers deliver evidence-based, personalized
treatment to same-sex couples to optimize clinical
outcomes without administering unnecessary tests or
treatments.
Conclusions
The experience of same-sex female couples differs
from that of heterosexual couples undergoing fertility
treatment. Many same-sex female couples suffer from
social rather than medical infertility, making their
sole barrier to conception access to viable sperm. This
is the first study to investigate the clinical value of the
MLP assessment in same-sex female couples under-
going hCG-triggered natural cycles with dsIUI. Our
results show that MLP assessment does not appear to
be associated with differences or improvements in CP
outcomes in this population. Clinicians should recon-
sider the evaluation of the MLP within same-sex
female couples who use dsIUI, as there is no com-
pelling justification for its use in patients without
medical infertility, it may also be an example of
over-medicalization of social infertility. The MLP
assessment is just one example of an intervention
that may be used in same-sex female couples with-
out benefit. Future research should continue to
evaluate specific considerations of testing and inter-
ventions in LGBT patients such that protocols can
be patient centered and evidence based.
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It has been suggested that medicalization adds to
healthcare costs without improving treatment.
37
While
the medicalization of infertility and the advent of ART
have allowed for the creation of alternative family
structures (i.e., with single or same-sex parents), treat-
ment protocols should be tailored to same-sex female
couples such that they are not unnecessarily subjected
to clinically invaluable, costly, or time-consuming tests
and interventions.
Authors’Contributions
I.C.B.: Writing—original draft preparation (lead), pro-
ject administration (lead), visualization (equal), formal
analysis (equal), and writing—review and editing
(equal). S.L.E.: Formal analysis (equal), investigation
(equal), and writing—review and editing (equal).
J.A.L.: Conceptualization, methodology, resources
(lead), and writing—review and editing (equal). M.B.:
Data curation (lead), formal analysis (equal), investiga-
tion (equal), and visualization (equal). N.C.: Writing—
original draft preparation. D.S.: Conceptualization,
methodology, and writing—review and editing (equal).
T.M.: Conceptualization, methodology, and writing—
review and editing (equal). A.B.C.: Conceptualization,
methodology, writing—review and editing (equal), and
supervision. J.F.: Conceptualization (lead), methodol-
ogy (equal), writing—review and editing, and supervi-
sion (lead). All authors agreed to the submission of
this article to the Journal of Women’sHealth.
Data Availability
Data regarding any of the subjects in the study have
not been previously published unless specified. Data
will be made available to the editors of the journal for
review or query upon request.
Author Disclosure Statement
A.B.C. is currently a company officer and direct stock-
holder for Progyny. D.S. is the Medical Director of
WINFertility. None of the remaining authors have per-
sonal, professional, or financial interest in any of the
products, devices, or drugs mentioned in this article.
Funding Information
The authors did not receive support from any organi-
zation for the submitted work.
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Cite this article as: Ban IC, Estevez SL, Lee JA, Baird M, Copperman N,
Stein D, Mukherjee T, Copperman AB, Friedenthal J (2024) Is there clini-
cal value in the mid-luteal progesterone check in same-sex female cou-
ples undergoing donor sperm intrauterine insemination? Women’s
Health Reports 5:1, 965–972, DOI: 10.1089/whr.2024.0056.
Abbreviations Used
AMH ¼Anti-M€
ullerian hormone
ART ¼Assisted reproductive technology
ASRM ¼American Society for Reproductive Medicine
BMI ¼Body mass index
CI ¼Confidence interval
CP ¼Clinical pregnancy
D3FSH ¼Day 3 follicle-stimulating hormone
dsIUI ¼Donor sperm intrauterine insemination
EnT ¼Endometrial thickness
hCG ¼Human chorionic gonadotropin
IUI ¼Intrauterine insemination
IVF ¼In vitro fertilization
LPD ¼Luteal phase deficiency
MLP ¼Midluteal progesterone
OI ¼Ovulation induction
OI-IUI ¼Ovulation induction followed by intrauterine insemination
OP ¼Ongoing pregnancy
OPK ¼Ovulation predictor kits
OR ¼Odds ratio
SD ¼Standard deviation
Band, et al.; Women’s Health Reports 2024, 5.1
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