Comparison of Dydrogesterone and GnRH Antagonists for Prevention of Premature LH Surge in IVF/ICSI Cycles: A Randomized Controlled Trial

Rashidi, Batool Hossein; Tarafdari, Azam; Ghazimirsaeed, Seyedeh Tahereh; Tehraninezhad, E Shahrokh; Keikha, Fatemeh; Eslami, Bita; Ghazimirsaeed, Seyede Masomeh; Jafarabadi, Mina

doi:10.18502/jfrh.v14i1.3783

Cited by 7 publications

(7 citation statements)

References 26 publications

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“…The study that best aligns with our reported CLBRs demonstrated that women aged between 35 and 40 years achieved a CLBR of approximately 51–66% in double-ET and 56–70% in single-ET, without specifying the stimulation protocol ( Mejia et al , 2021 ). PPOS-related protocols are preferable for older women or those with low ovarian reserve because they are better at preventing early LH surges than GnRH antagonists and thus help in obtaining more mature oocytes ( Hossein Rashidi et al , 2020 ). Perhaps for this reason, the PPOS-related scheme has an advantage over the traditional scheme in women above 40 years old.…”

Section: Discussionmentioning

confidence: 99%

The cumulative live birth rates of 18 593 women with progestin-primed ovarian stimulation-related protocols and frozen-thawed transfer cycles

Nie,

Guo,

Shen

et al. 2023

Human Reproduction Open

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STUDY QUESTION What are the odds of achieving pregnancy when adopting progestin-primed ovarian stimulation (PPOS)-related protocols combined with repetitive frozen–thawed transfer (FET) cycles in patients with different clinical characteristics? SUMMARY ANSWER The cumulative live birth rates (CLBRs) of women undergoing different PPOS-related protocols can be significantly and consistently enhanced within six FET cycles when the female age is < 40 years (or even <45 years) and when >5 oocytes are retrieved, regardless of antral follicle count (AFC). WHAT IS KNOWN ALREADY There have been numerous studies on the live birth rate of the first FET cycle in patients with PPOS-related protocols. These studies have focused mainly on comparing pregnancy outcomes with those of other stimulation protocols. However, owing to the unique features of the PPOS-related strategy, such as its flexible timing of oocyte retrieval and repeated transfer of frozen embryos, studies using the CLBR as an overall indicator of success and investigating which types of patients would benefit from this protocol are lacking. STUDY DESIGN, SIZE, DURATION This retrospective cohort study included 18,593 women who underwent PPOS-related protocols (dydrogesterone + hMG, medroxyprogesterone acetate + hMG, micronized progesterone + hMG treatment, and luteal-phase ovarian stimulation protocol) from 1 March 2011 to 31 September 2022 in our centre. PARTICIPANTS/MATERIALS, SETTING, METHODS The population was categorized by female age, number of oocytes retrieved, and AFC in the analysis of CLBR within six FET cycles. The age groups (groups 1-5, respectively) were <30, 30-34, 35-39, 40-44, and ≥45 years. The number of oocytes retrieved was grouped as 1-5, 6-10, 11-15, 16-20, and >20. AFC was grouped as < 5, 5-10, 11-15, and >15. The Kaplan–Meier analysis (optimistic method), which hypothesized that patients who did not continue treatment had the same chance of achieving a live birth as those who continued, and the competing risk method (conservative method) which hypothesized they had no chance of achieving a live birth, were applied. In further analyses, the Cox model and Fine–Gray model were adopted: the former corresponds to the optimistic scenario, and the latter corresponds to the pessimistic scenario. MAIN RESULTS AND THE ROLE OF CHANCE CLBR had a declining trend with female age over six FET cycles (groups 1-5, respectively: optimistic: 96.9%, 96.6%, 91.4%, 67.3%, and 11.7%; conservative: 87.3%, 85.0%, 74.0%, 41.3%, and 7.5%), requiring more FET cycles to achieve a success rate of at least 50% (groups 1-5, respectively: optimistic: 2, 2, 2, 4 and >6 cycles; conservative: 2, 2, 2, > 6 and > 6 cycles). CLBR showed an increasing trend with the number of oocytes retrieved (groups 1-5, respectively: optimistic: 93.8%, 94.3%, 95.8%, 96.0%, and 95.6%; conservative: 66.2%, 78.3%, 85.6%, 88.9%, and 91.0%). All groups needed the same number of FET cycles to achieve a success rate of at least 50% (groups 1-5, respectively: optimistic: 2, 2, 2, 2 and 2 cycles; conservative: 2, 2, 2, 2 and 2 cycles). Furthermore, the CLBR within six FET cycles had an increasing trend with AFC number (groups 1-4, respectively: optimistic: 89.2%, 94.8%, 95.9%, and 96.3%; conservative: 67.4%, 78.2%, 83.9%, and 88.1%), with all four groups achieving a success rate of at least 50% by the second FET cycle. LIMITATIONS, REASONS FOR CAUTION The current research is limited by its retrospective design and single-centre nature, which may restrict the generalizability of our findings. WIDER IMPLICATIONS OF THE FINDINGS This work describes two models (the Kaplan–Meier analysis and the competing risk method) to evaluate the clinical outcome of patients using PPOS-related protocols, which are especially useful for patients of advanced age or those with diminished ovarian reserve. Our findings encourage patients below 45 years old, especially younger than 40 years, and patients with lower AFCs and fewer retrieved oocytes to try this new protocol. Moreover, this study demonstrates the degree of improvement in the CLBR within six FET cycles for patients with different clinical characteristics, providing a valuable point of reference to determine whether to continue ART after a transfer failure. STUDY FUNDING/COMPETING INTEREST(S) The study was supported by grants from the National Natural Science Foundation of China (grant number: 82071603 to L.W., 82001502 to Y. Liu). There are no conflicts of interest to declare. TRIAL REGISTRATION NUMBER Not applicable.

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Section: Discussionmentioning

confidence: 99%

The cumulative live birth rates of 18 593 women with progestin-primed ovarian stimulation-related protocols and frozen-thawed transfer cycles

Nie,

Guo,

Shen

et al. 2023

Human Reproduction Open

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“…According to the findings, to inhibit a premature increase in LH in IVF cases, Duphaston is used as a suitable alternative to Cetrotide in patients undergoing ovarian stimulation because it is more effective and has fewer side effects than Cetrotide. Moreover, Duphaston may be a better alternative in clinical practice because oral administration is more patient-friendly than parenteral administration [22] . The limitations of this study were its non-pregnancy and neonatal outcomes.…”

Section: Discussionmentioning

confidence: 99%

Duphaston as a suitable medication for women taking intracytoplasmic sperm injection to treat infertility

Naserpour,

Berjis,

Soleymani Moud

et al. 2023

Reproductive and Developmental Medicine

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Objective: Duphaston is used as an alternative to gonadotropin-releasing hormone (GnRH) antagonists for suppressing premature luteinizing hormone (LH) surges. This study aimed to compare the efficacy of Duphaston protocols with that of Cetrotide in suppressing the LH surge. Methods: In this retrospective cross-sectional study, 669 infertile women (aged 25–40 years) were administered recombinant follicle-stimulating (rFSH) hormone from the third day of their menstrual cycle. After the follicular diameter reached–13-14 mm, Cetrotide was prescribed orally to the control subjects, also case subjects took Duphaston orally. The retrieved oocytes were fertilized by an intracytoplasmic sperm injection (ICSI). Results: The levels of FSH, LH, and estradiol did not differ significantly between the groups (P >0.05). However, the findings indicated that Duphaston led to greater oocyte retrieval than Cetrotide (P=0.006). However, the number of mature oocytes and viable embryos in the case subjects did not reach a significant difference compared to that in the control subjects (P >0.05). The number of good-quality embryos (stage1) was significantly higher in the case subjects (P =0.04). In addition, there is no significant difference in the chemical, clinical pregnancy, implantation rate, and miscarriage rate between both groups (P >0.05) . Conclusion: Duphaston could be utilized as a suitable medication rather than a GnRH antagonist in women subjected to controlled ovarian hyperstimulation.

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“…Dydrogesterone, as a powerful player in LPD management, can synergize with other medications to create a more effective and holistic treatment approach. This might involve the integration of dydrogesterone with other interventions commonly employed in fertility treatments, such as gonadotropins and gonadotropin-releasing hormone (GnRH) agonists [ 61 ].…”

Section: Reviewmentioning

confidence: 99%

The Role of Dydrogesterone in the Management of Luteal Phase Defect: A Comprehensive Review

Muneeba,

Acharya,

Mohammad

2023

Cureus

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The luteal phase of the menstrual cycle is a pivotal period characterized by hormonal intricacies that lay the foundation for successful embryo implantation and early pregnancy development. Luteal phase defect (LPD), marked by abnormalities in luteal function, presents challenges that can impede reproductive outcomes. This comprehensive review article explores the role of dydrogesterone in LPD management, elucidating its mechanisms of action, evidence of efficacy, safety profile, and potential in combination therapies. Dydrogesterone, a synthetic progestogen, closely mirrors natural progesterone's actions, effectively supplementing the luteal phase and enhancing endometrial receptivity. Clinical studies demonstrate improved pregnancy rates, extended luteal phase support, and enhanced reproductive outcomes with dydrogesterone supplementation. Its favorable safety profile, minimal side effects, and reduced risk of unwanted hormonal effects contribute to its appeal. Furthermore, dydrogesterone's inclusion in international guidelines solidifies its importance in LPD management. Combination therapies, leveraging synergistic effects, offer a comprehensive approach. As gaps in knowledge persist, future research directions and personalized treatment strategies pave the way for a future where dydrogesterone stands as a beacon of hope in conquering the challenges of LPD and achieving successful reproductive outcomes.

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Comparison of Dydrogesterone and GnRH Antagonists for Prevention of Premature LH Surge in IVF/ICSI Cycles: A Randomized Controlled Trial

Cited by 7 publications

References 26 publications

The cumulative live birth rates of 18 593 women with progestin-primed ovarian stimulation-related protocols and frozen-thawed transfer cycles

The cumulative live birth rates of 18 593 women with progestin-primed ovarian stimulation-related protocols and frozen-thawed transfer cycles

Duphaston as a suitable medication for women taking intracytoplasmic sperm injection to treat infertility

The Role of Dydrogesterone in the Management of Luteal Phase Defect: A Comprehensive Review

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