Use of medroxyprogesterone acetate in women with ovarian endometriosis undergoing controlled ovarian hyperstimulation for in vitro fertilization

Guo, Haiyan; Wang, Yun; Chen, Qiuju; Chai, Weidong; Sun, Lihua; Ai, Ai; Fu, Yonglun; Lyu, Qifeng; Kuang, Yanping

doi:10.1038/s41598-017-12151-7

Cited by 20 publications

(20 citation statements)

References 53 publications

(55 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Long-acting FSH has also been used in a fashion of random start with antagonist protocol [26], but there is lack of investigation specific to luteal stimulation. As for PPOS without GnRH antagonist, the group in China led by Kuang [8,10,27 Almost all previous relevant studies unanimously required higher dosage of HMG with or without longer duration for stimulation in MPA-PPOS [8,12,33]. In our finding, there was no significant difference in stimulation duration and gonadotrophin consumption between PPOS and antagonist protocol.…”

Section: Resultssupporting

confidence: 43%

Validation of an extremely patient-friendly progestin-primed ovarian stimulation protocol in normal and high responders by comparing with conventional antagonist protocol: a retrospective study

Huang

Chen

Shieh

et al. 2020

Preprint

View full text Add to dashboard Cite

Background. Our previous study has shown a satisfactory reproductive outcome resulting from the extremely patient-friendly ovarian stimulation protocol of long-acting follicle stimulation hormone (FSH) plus oral medroxyprogesterone acetate (MPA). The present study was aimed to compare the efficacy of the extremely patient-friendly ovarian stimulation protocol with that of antagonist protocol.Methods. A retrospective study was conducted on normal and high responders aged from 24 to 39 years starting ovarian stimulation for IVF/ICSI with long-acting FSH at early follicular phase in a tertiary fertility center in Taiwan between December 2016 and August 2017. To prevent premature luteinizing hormone (LH) surge, oral MPA was applied in some cycles (group 1), whereas antagonist protocol was applied in other cycles (group 2). Freezing all embryos was applied to all patients in both groups. Duration of stimulation, number of shots and visits before trigger, incidence of premature LH surge, number of oocytes retrieved, fertilization rate, cleavage rate, rate of good embryos available, incidence of ovarian hyperstimulation syndrome, cumulative clinical pregnancy rate, and cumulative live birth rate per retrieval were compared between groups. Results. One hundred and ten cycles of IVF/ICSI were included, among which there were fifty-seven cycles in group 1 and fifty-three cycles in group 2. Starting with long-acting FSH, group 1 (MPA) required much fewer injections and visits but had comparable reproductive outcomes to those in group 2 (antagonist protocol).Conclusions. Long-acting FSH plus MPA use for ovarian stimulation is extremely friendly for the patients and demonstrates satisfactory stimulation and reproductive outcomes that are comparable to those of antagonist protocol.

show abstract

Section: Resultssupporting

confidence: 43%

Validation of an extremely patient-friendly progestin-primed ovarian stimulation protocol in normal and high responders by comparing with conventional antagonist protocol: a retrospective study

Huang

Chen

Shieh

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…This was a prospective non-inferiority trial. The sample size was estimated according to previous studies (9)(10)(11)(12)16). We assumed that the mean number of oocytes retrieved in the three groups was 10.0 oocytes (18) and the non-infertility margin was 2.0 oocytes.…”

Section: Sample Sizementioning

confidence: 99%

“…Patients with thin endometria during natural or stimulation cycles were recommended to adopt the hormone replacement protocol. A hormone substituted cycle was performed for patients with thin endometria during natural or stimulation cycles which had be previously described (16). The maximum number of transferred embryos was two per patient.…”

Section: Transfer Of Cryopreserved-thawed Embryosmentioning

confidence: 99%

“…Progesterone can be an effective preventive measure for moderate/severe ovarian hyperstimulation syndrome (OHSS) in controlled ovarian stimulation in normal ovulatory women and patients with polycystic ovarian syndrome (PCOS), with the promising advantages of oral administration, user convenient, and low cost (9,13,14). Our previous study have shown that dydrogesterone (DYG) (15) is an appropriate oral alternative for the progesterone priming ovary stimulation (PPOS) protocol and MPA is an effective option for patients with severe endometriosis during IVF-ET (16).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Efficacy of Different Progestins in Women With Advanced Endometriosis Undergoing Controlled Ovarian Hyperstimulation for in vitro Fertilization-A Single-Center Non-inferiority Randomized Controlled Trial

Guo

Shen

et al. 2020

Front. Endocrinol.

Self Cite

View full text Add to dashboard Cite

Is it possible to use different progestins cotreatment with human menopausal gonadotrophin (hMG) in women with advanced endometriosis but normal ovulation during controlled ovarian hyperstimulation (COH) in vitro fertilization (IVF)? Whether different progestins treatments can be an alternative choice for women with severe endometriosis in considering IVF/ICSI treatment remains unknown? Design: Non-inferiority randomized clinical trial. Setting: Tertiary-care academic medical center. Population: Four hundred and fifty infertile patients with severe endometriosis undergoing IVF/ICSI between May 2016 and March 2017. Methods: Four hundred and fifty infertile patients with severe endometriosis undergoing IVF/ICSI were randomized to: medroxyprogesterone acetate +hMG; dydrogesterone +hMG; and progesterone +hMG. Ovulation was induced with a gonadotropin-releasing hormone agonist (GnRH-a) and chorionic gonadotropin (hCG). Viable embryos were cryopreserved for later transfer. Main Outcome Measures: The primary endpoint outcome was the number of oocytes retrieved. Secondary indicators included the incidence of a premature surge in luteinizing hormone (LH), the number of viable embryos, and clinical pregnancy outcomes. Results: The number of oocytes retrieved was higher in the medroxyprogesterone acetate +hMG group than the two other groups (9.3 ± 5.7 vs. 8.0 ± 4.5 vs. 7.8 ± 5.2, P = 0.021). LH levels were suppressed after a 6-day progestin treatment in the medroxyprogesterone acetate +hMG and dydrogesterone +hMG groups, but there was Guo et al. Progestins in Endometriosis and IVF a rebound of LH values in the progesterone +hMG group. No premature LH surge and ovarian hyperstimulation syndrome (OHSS) occurred. No significant differences among the three groups were observed in fertilization and pregnancy outcomes. Conclusion: It is mandatory to point out that our conclusions are valid for patients with ovarian advanced endometriosis but normal ovarian functions. These results suggest three different progestins protocols are equivalent in terms of pregnancy outcomes for women with advanced endometriosis. PPOS protocol can be an alternative choice for women with severe endometriosis and normal ovarian reserve in IVF/ICSI treatment. These methods could be tested with other populations of women with endometriosis.

show abstract

“…8,9 Prior studies have shown that the PPOS protocol with medroxyprogesterone acetate (MPA) could produce competent oocytes/embryos and achieve comparable pregnancy outcomes to standard GnRH agonist short protocol. 7,10,11 Coupled with the application of frozenthawed embryo transfer (FET) and dual trigger of GnRH agonist with low-dose hCG, the PPOS protocol also allows for nearly complete avoidance of OHSS occurrence. 12 Nevertheless, use of MPA in the PPOS regimen tends to inhibit pituitary in a more profound manner and therefore requires higher doses of hMG than the GnRH agonist short protocol in patients with or without PCOS.…”

Section: Introductionmentioning

confidence: 99%

<p>Progestin-Primed Ovarian Stimulation with Dydrogesterone versus Medroxyprogesterone Acetate in Women with Polycystic Ovarian Syndrome for in vitro Fertilization: A Retrospective Cohort Study</p>

Huang

Xie

Lin

et al. 2020

DDDT

Self Cite

View full text Add to dashboard Cite

Dydrogesterone (DYG) is an alternative progestin in progestin-primed ovarian stimulation (PPOS) protocol with weaker pituitary suppression than medroxyprogesterone acetate (MPA) in normal ovulatory women. However, the endocrinological characteristics, oocyte retrieval and pregnancy outcomes of DYG application in polycystic ovarian syndrome (PCOS) patients undergoing in vitro fertilization (IVF) remain unclear. Patients and methods: This retrospective cohort study included 420 PCOS patients who underwent controlled ovarian stimulation with human menopausal gonadotropin (hMG) and DYG (n=105) or MPA (n=315) from January 2014 to December 2017. Baseline characteristics of the two groups were balanced with propensity score matching using the nearestneighbor random matching algorithm in a ratio of 1:3. The primary outcome measure was the number of oocytes retrieved. Other main outcome measures included the number of viable embryos, incidence of premature luteinizing hormone (LH) surge and live birth rate per frozen-thawed embryo transfer (FET) cycle. Results: A similar number of oocytes was retrieved in the two protocols (16.1±6.5 vs 15.1±10.0, P=0.342). Patients in both groups achieved consistent LH suppression with no premature LH surge detected. In the DYG + hMG group, the mean LH levels were significantly higher than the MPA + hMG group on cycle day 9-11 and trigger day (all P<0.001), and the dose of hMG was significantly lower (1710.7±431.6 vs 1891.3±402.2 IU, P<0.001). No significant between-group differences were found in the number of viable embryos (5.3±3.1 vs 5.0±4.1, P=0.139) and live birth rate per FET cycle (43.5% vs 47.7%, P=0.383). None of the participants experienced moderate-to-severe ovarian hyperstimulation syndrome in either group. Conclusion: Our results showed that the application of DYG in PPOS protocol could achieve comparable oocyte retrieval and pregnancy outcomes to MPA, but significantly reduce the consumption of gonadotropins in PCOS women for IVF treatment.

show abstract

Use of medroxyprogesterone acetate in women with ovarian endometriosis undergoing controlled ovarian hyperstimulation for in vitro fertilization

Cited by 20 publications

References 53 publications

Validation of an extremely patient-friendly progestin-primed ovarian stimulation protocol in normal and high responders by comparing with conventional antagonist protocol: a retrospective study

Validation of an extremely patient-friendly progestin-primed ovarian stimulation protocol in normal and high responders by comparing with conventional antagonist protocol: a retrospective study

Efficacy of Different Progestins in Women With Advanced Endometriosis Undergoing Controlled Ovarian Hyperstimulation for in vitro Fertilization-A Single-Center Non-inferiority Randomized Controlled Trial

<p>Progestin-Primed Ovarian Stimulation with Dydrogesterone versus Medroxyprogesterone Acetate in Women with Polycystic Ovarian Syndrome for in vitro Fertilization: A Retrospective Cohort Study</p>

Contact Info

Product

Resources

About