Luteinizing Hormone Suppression by Progestin-Primed Ovarian Stimulation Is Associated With Higher Implantation Rate for Patients With Polycystic Ovary Syndrome Who Underwent in vitro Fertilization/Intracytoplasmic Sperm Injection Cycles: Comparing With Short Protocol

Abstract

BackgroundMany studies have demonstrated the positive clinical value of progestin-primed ovarian stimulation (PPOS) in patients with polycystic ovary syndrome (PCOS) who underwent assisted reproductive technology. However, the underlying factors contributing to this phenomenon remain unclear. We conducted a retrospective observational study to compare the clinical outcomes of women with PCOS who underwent PPOS or the short protocol to identify possible factors that influence the outcome.MethodsThis study included 304 patients who underwent PPOS and 152 patients who underwent short protocol from April 2014 to July 2019 after propensity-score matching. Human menopausal gonadotropin (hMG) dose, hormone profile, embryo development, and clinical outcomes of frozen-thawed embryo transfer (FET) cycles were compared. The primary outcome measure was the implantation rate. Logistic regression was performed to identify contributing factors, and receiver operating characteristic curve analysis was used to calculate the cutoff of luteinizing hormone (LH) difference ratio in clinical outcomes.ResultsCompared with the short protocol, PPOS resulted in a higher implantation rate (43.4% vs. 31.9%, P < 0.05), clinical pregnancy rate (61.8% vs. 47.4%, P < 0.05), and live birth rate (48.4% vs. 36.8%, P < 0.05). Similar fertilization, cleavage, and valid embryo rate per oocyte retrieved between groups were observed. The LH difference ratio was positively associated with implantation rate [P = 0.027, odds ratio (OR) = 1.861, 95% CI: 1.074–3.226]. The relationship between the LH difference ratio with clinical outcomes was confirmed by receiver operating characteristic curve analysis and comparisons among patients grouped by the LH difference ratio.ConclusionThe implantation rate was associated with the LH difference ratio during ovary stimulation in patients with PCOS. Our results provide the explanation why PPOS shows the positive clinical outcomes for patients with PCOS.

Letrozole cotreatment with progestin-primed ovarian stimulation in women with polycystic ovary syndrome undergoing IVF treatment

“…In the present study, the mean LH level of the letrozole combined with the PPOS regimen seemed more stable and appropriate than that in the PPOS protocol alone. Nevertheless, contrary studies demonstrated that LH suppression by PPOS was associated with a higher implantation rate for patients with PCOS than with a short protocol (Chen et al, 2021). Hence, the optimal LH level required for the PPOS protocol in PCOS patients is worth exploring.…”

Efficacy of progestin-primed ovarian stimulation in women with polycystic ovary syndrome undergoing in vitro fertilization: a systematic review and meta-analysis

“…We included three RCTs ( 15 , 16 , 33 ) and six retrospective cohort studies ( 11 , 17 , 29 – 32 ) involving 2289 women. Most included studies were conducted in China ( 11 , 15 , 17 , 30 – 33 ), and the others were in Japan ( 29 ) and Iran ( 16 ). The average age of women was 28-34 years old.…”

“…The average age of women was 28-34 years old. Four studies ( 15 , 17 , 31 , 32 ) applied medroxyprogesterone acetate (MPA) as the oral progestin in the PPOS group; two used GnRH-a short protocol in the control group, and the other two used GnRH antagonist protocol. Three studies ( 16 , 29 , 30 ) used dydrogesterone in the PPOS group, with GnRH antagonist protocol in all control groups.…”

“…However, the benefits of the PPOS protocol for patients with PCOS-related infertility are still controversial. For example, a previous randomized trial showed that this new progesterone protocol did not improve the cumulative pregnancy rate or reduce the risk of moderate/severe OHSS for women with PCOS ( 16 ), while a recent cohort study ( 17 ) suggested it was associated with a higher implantation rate, clinical pregnancy rate, and live birth rate. Thus, conducting a systematic review and meta-analysis is necessary to provide evidence clarifying the efficacy of the PPOS protocol for infertile women with PCOS undergoing IVF/ICSI.…”

The comparison between fixed versus degressive doses of medroxyprogesterone acetate combined with letrozole in patients of progestin-primed ovarian stimulation protocol: a propensity score-matched study

“…Previous studies have reported varying LH levels on the hCG trigger day in different patient groups using the MPA protocol. In women with PCOS, LH levels ranged from 1.62 to 2.52 IU/L ( 40 – 43 ), while in infertile women with normal ovarian reserve, LH levels were between 1.56 and 3.54 IU/L ( 12 , 14 , 44 – 46 ). Poor responders showed LH levels in the range of 2.4 to 5.55 IU/L ( 6 , 47 – 49 ).…”