Ovarian stimulation in the luteal phase: systematic review and meta-analysis

Abstract

Purpose The purpose of this study was to evaluate whether outcomes are different if controlled ovarian stimulation (COS) is started in the luteal phase rather than the follicular phase. Methods A systematic review and meta-analysis was performed. Sixteen studies were included in the qualitative analysis, and eight studies with a total of 338 women were included in the quantitative analysis. Results Cycles initiated in the luteal phase were slightly longer (WMD 1.1 days, 95 % CI 0.39-1.9) and utilized more total gonadotropins (WMD 817 IU, 95 % CI 489-1144). However, no differences were noted in peak estradiol levels (WMD −411 pg/ml, 95 % CI −906-84.7) or in the total number of oocytes retrieved (WMD 0.52 oocytes, 95 % CI −0.74-1.7). There were slightly more mature oocytes retrieved in the luteal phase (WMD 0.77 oocytes, 95 % CI 0.21-1.3), and fertilization rates were significantly higher (WMD 10 %, 95 % CI 0.03-0.18). While only three studies reported pregnancy outcomes, no difference was noted in the FET pregnancy rates after COS in the luteal versus follicular phase (RR 0.95, 95 % CI 0.56-1.7).A post hoc power analysis revealed that a sample of this size was sufficient to detect a clinically meaningful difference of 2 oocytes retrieved with 93 % power.Conclusion Although initiating COS in the luteal phase requires a longer stimulation and a higher dose of total gonadotropin, these differences are not clinically significant. Furthermore, COS initiated in the luteal phase does not compromise the quantity or quality of oocytes retrieved compared to outcomes of traditional stimulation in the follicular phase.

Random‐start ovarian stimulation with aromatase inhibitor for fertility preservation in women with Japanese breast cancer

“…The number of retrieved oocytes in the LPS was similar to that of the FPS. This result was consistent with the findings reported in previousstudies . A previous study showed that there was no elevated rate of abnormality at birth after LPS compared to FPS .…”

“…This result was consistent with the findings reported in previousstudies. 15,16 A previous study showed that there was no elevated rate of abnormality at birth after LPS compared to FPS. 17 Another study showed that euploid blastocyst rate calculated either per biopsied blastocyst or injected MII oocyte was not significantly different between FPS and LPS groups.…”

The pregnancy outcome of progestin‐primed ovarian stimulation using 4 versus 10 mg of medroxyprogesterone acetate per day in infertile women undergoing in vitro fertilisation: a randomised controlled trial

“…Pituitary function is suppressed by the continuous supply of progestin during PPOS . It was reported that a dose of 10 mg of medroxyprogesterone acetate (MPA) per day could effectively inhibit spontaneous ovulation in both the natural cycle and in cycles of ovarian stimulation .…”

Recent advances in oncofertility care worldwide and in Japan

“…The drugs that are used to inhibit the spontaneous luteinizing hormone surge include not only the conventional GnRH antagonists, but also medroxyprogesterone acetate. 27 In a recent meta-analysis of a total of 338 women who | 359 TAKAI underwent ovarian stimulation (251 of whom did so for fertility preservation) that began in the luteal phase, 28 the duration and dosage of the FSH preparations were significantly higher than in a control group of women, in whom ovarian stimulation was initiated in the early follicular phase. However, there were no significant differences in the number of retrieved oocytes, cryopreserved embryos, or peak estradiol levels.…”

“…These findings suggest that in random-start protocols, ovarian stimulation lasts 1-2 days longer, resulting in an increase in the dosage of the fertility drugs; however, the number of retrieved oocytes is similar to the number that is retrieved with the conventional protocol. For the ovarian stimulation of infertile women that was initiated in the luteal phase, the pregnancy rate that was achieved with cryopreserved embryos was reported to be similar to the rates for conventional ovarian stimulation 28 ; however, there are currently few studies featuring a comparison of pregnancy rates between the random-start and conventional stimulation protocols and no study of the pregnancy rates in women who are undergoing ovarian stimulation for fertility preservation.…”