Medroxyprogesterone Acetate versus Gonadotropin-Releasing Hormone Antagonist for the Prevention of Premature Luteinizing Hormone Surge in hyper-responder women undergoing controlled ovarian stimulation for IVF/ICSI Cycles

Abstract

Objective:To compare the effect of Medroxyprogesterone acetate versus Gonadotropin releasing hormone antagonist for the prevention of premature luteinizing hormone (LH) surge in infertile hyper-responder women undergoing controlled ovarian stimulation for in vitro fertilization (IVF) /intracytoplasmic sperm injection (ICSI) cycles.Methods: One hundred infertile hyper-responder women who were candidate for IVF/ICSI were randomly assigned into two groups. Group 1 was given 20 mg Medroxyprogesterone acetate from day 1 of the menstrual cycle till trigger day. Group 2 was given GnRH antagonist (injection Cetrorelix 0.25 mg s/c) from the day when the leading follicle reached 14 mm until the day of trigger for the prevention of premature LH surge (flexible protocol).We measured LH serum levels on day 1, day 7 of cycle and on trigger day. The primary outcome measured was the incidence of premature LH surge. Other outcome measures were total number of mature follicles on trigger day, total number of mature oocytes retrieved and number of good quality day-3 embryos.Results: There was no premature luteinizing hormone surge in both groups of our study. The mean number of follicles on trigger day, mean number of M2 oocytes retrieved and mean number of good quality day-3 embryos were comparable in both the groups, with no statistically significant difference. Conclusions:The results of this study stated that MPA can be an effective alternative to GnRH antagonist for the prevention of premature LH surge in hyper-responder women undergoing COS for IVF. It is easy to use, widely available and cost-effective. It may establish a new regimen of ovarian stimulation using MPA as an oral alternative to GnRH antagonist treatment in hyper-responders.

Progestin-primed ovarian stimulation

“…Nowadays, as evidenced by the meta-analysis conducted by Yang et al, polycystic ovarian syndrome (PPOS results in a similar risk of OHSS, number of oocytes retrieved or pregnancy outcomes in PCOS patients undergoing IVF/ICSI compared to conventional protocols [22 && ]. Similarly, there appear to be no differences in cycle features in hyper-responder women [23].…”

Live Birth Outcomes for PCOS Patients Under the Follicular-Phase Long-Acting GnRH Agonist Protocol or Antagonist Protocol – A Retrospective Chinese Cohort

“…Firstly, it may be possible due to the progesterone level elevation. PCOS patients with a high number of oocytes retrieved tended to have premature luteinization 17 and indicating an increased progesterone concentration (≥1.3 ng/mL) on the day of hCG administration so that the implantation window would shift forward. 18 The fact that LBR is better in the depot GnRH agonist protocol may be associated with a reduction in P level on the day of hCG administration for pituitary down-regulation before gonadotrophin stimulation.…”