Use of progestins to inhibit spontaneous ovulation during ovarian stimulation: the beginning of a new era?

Marca, Antonio La; Capuzzo, Martina

doi:10.1016/j.rbmo.2019.03.212

Cited by 60 publications

(35 citation statements)

References 52 publications

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“…Progestin-primed ovarian stimulation (PPOS) is another commonly used regimen in patients with POR. However, the benefits of the PPOS regimen (including the lower cost, oral administration, and reduced risk of ovarian hyperstimulation syndrome vs GnRH regimens) are countered by the need for ‘freeze-all’ cycles and the inability to pursue a more rapid fresh embryo transfer procedure ( 16 , 17 ).…”

Section: Introductionmentioning

confidence: 99%

Comparison of Cumulative Live Birth Rates Between GnRH-A and PPOS in Low-Prognosis Patients According to POSEIDON Criteria: A Cohort Study

Zhang

Yin

et al. 2021

Front. Endocrinol.

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ObjectiveTo compare the cumulative live birth rate (CLBR) of a gonadotropin-releasing hormone (GnRH) antagonist regimen and a progestin-primed ovarian stimulation (PPOS) regimen in low-prognosis patients according to POSEIDON criteria.DesignSingle-center, retrospective, observational study.SettingHenan Provincial People’s Hospital, Zhengzhou, ChinaPatientsWomen aged ≤40 years, with a body mass index <25 kg/m2, who underwent in vitro fertilization (IVF) or intracytoplasmic sperm microinjection (ICSI) and met POSEIDON low-prognosis criteria.InterventionGnRH or PPOS regimen with IVF or ICSI.Main Outcome MeasureCLBR per oocyte retrieval cycle.ResultsPer oocyte retrieval cycle, CLBR was significantly higher with GnRH antagonist versus PPOS (35.3% vs 25.2%; P<0.001). In multivariable logistic regression analysis, CLBR per oocyte retrieval cycle was significantly lower with PPOS versus GnRH antagonist before (OR 0.62 [95% confidence intervals (CI): 0.46, 0.82; P=0.009]) and after (OR 0.66 [95% CI: 0.47, 0.93; P=0.0172]) adjustment for age, body mass index, infertility type, infertility duration, baseline follicle stimulating hormone, anti-Müllerian hormone (AMH), antral follicle count (AFC), and insemination method. CLBR was numerically higher with the GnRH antagonist regimen than with PPOS, across all of the POSEIDON groups, and was significantly higher in patients aged ≥35 years with poor ovarian reserve [AFC <5, AMH <1.2 ng/mL] (unadjusted, P=0.0108; adjusted, P=0.0243).ConclusionIn this single-center, retrospective, cohort study, patients had a higher CLBR with a GnRH antagonist versus PPOS regimen, regardless of other attributes.

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Section: Introductionmentioning

confidence: 99%

Comparison of Cumulative Live Birth Rates Between GnRH-A and PPOS in Low-Prognosis Patients According to POSEIDON Criteria: A Cohort Study

Zhang

Yin

et al. 2021

Front. Endocrinol.

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“…However, PPOS may be the best option for conditions in which fresh embryo transfer is not appropriate, such as donor cycles, preimplantation genetic testing cycles, fertility preservation, and hyper-responsive patients with high risk of OHSS. 17 Very limited data are available regarding the clinical results of PPOS in hyper-responsive patients. In previous studies, the short agonist protocol was compared with PPOS.…”

Section: Introductionmentioning

confidence: 99%

“…However, natural progesterone may interfere with the measurement of serum progesterone, and premature luteinization may be neglected. 17,20 MPA was also suggested to lead to stronger pituitary suppression, and gonadotropin usage for longer periods and at higher dosages. 14 Therefore, the appropriate progestin type for the PPOS protocol has not been confirmed.…”

Section: Introductionmentioning

confidence: 99%

Dydrogesterone‐primed ovarian stimulation is an effective alternative to gonadotropin‐releasing hormone antagonist protocol for freeze‐all cycles in polycystic ovary syndrome

Gürbüz

Göde

2020

J of Obstet and Gynaecol

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Objective To compare the effects of progestin‐primed ovarian stimulation using dydrogesterone (DYD) and a gonadotropin‐releasing hormone (GnRH) antagonist protocol on cycle characteristics and pregnancy rates in freeze‐all cycles in patients with polycystic ovary syndrome (PCOS). Methods Medical records of PCOS patients who underwent freeze‐all in vitro fertilization cycles between April 2017 and April 2019 at the Novafertil in vitro fertilization Center were retrospectively evaluated. The primary outcome measure was the incidence of premature luteinizing hormone surge. Secondary outcome measures were the total number of mature oocytes retrieved, fertilization rate, clinical pregnancy rates and ongoing pregnancy rates. Results: A total of 525 patients were included in the study. DYD‐primed ovarian stimulation and a GnRH antagonist protocol were applied in 258 and 267 patients, respectively. The baseline parameters were similar between the two groups. The numbers of mature and fertilized oocytes were similar in the cetrorelix (CET) group and DYD group (11.43 ± 3.48 vs. 11.29 ± 4.34, respectively, P = 0.692; and 8.98 ± 2.93 vs. 8.62 ± 3.67, respectively, P = 0.208). Premature luteinization was rare in both groups, and the difference between the groups was not statistically significant (2.9% vs. 1.5%, respectively, P = 0.268). There was no significant difference in clinical pregnancy rate of the first frozen embryo transfer cycle between the DYG group and the CET group (56% [120/214] vs. 55.6% [113/203], respectively, P = 0.283). There were no significant differences in biochemical pregnancy rates, implantation rates, miscarriage rates or ongoing pregnancy rates between the two groups (P > 0.05). Conclusion Dydrogesterone‐primed ovarian stimulation seems to be an effective alternative to the GnRH antagonist protocol for freeze‐all cycles in PCOS patients.

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“…However, it is expensive and occasionally premature LH surge, undesired ovulation, and cycle cancellation were reported in some patients (11,12). So, its effectiveness is still under debate (13).…”

mentioning

confidence: 99%

“…Therefore, new regimens with improved efficacy and patients' convenience are needed to be established to prevent premature LH surges and research is still ongoing (13).…”

mentioning

confidence: 99%

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

Rashidi

Tarafdari

Ghazimirsaeed

et al. 2020

JFRH

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Objective: To compare the effect of dydrogesterone and GnRH antagonists on prevention of premature luteinizing hormone (LH) surge and pregnancy outcomes in infertile women undergoing IVF/ICSI. Materials and methods: In a Randomized controlled trial (RCT), two-hundred eligible women undergoing in vitro fertilization (IVF) /intracytoplasmic sperm injection (ICSI) treatment were randomly assigned into two groups. Human menopausal gonadotropin (HMG) was administered for controlled ovarian stimulation (COS) in both groups. Intervention group (group 1) received 20 mg dydrogesterone from day 2 of menstrual cycle till trigger day and control group (group2) received GnRH antagonist from the day that leading follicle reached 13 mm in diameter till trigger day. Serum levels of LH, estradiol and progesterone were measured on the trigger day. The primary outcome measure was the incidence of a premature LH surge, and the secondary outcomes investigated were the chemical and clinical pregnancy rates in the first FET cycles. Results: There were no significant differences in patients' age, BMI, AMH levels, previous IVF cycle, and cause of infertility between the two groups. None of the patients in two groups experienced a premature luteinizing hormone surge. The numbers of retrieved oocytes, the MII oocytes and good quality embryos, were significantly higher in the intervention group than antagonist group (p < 0.05). The overall chemical pregnancy rate in intervention group (43/91: 46.2%) and control group (45/91: 49.5%) (p = 0.820) was similar. Meanwhile, the clinical pregnancy rate was similar between groups too. Conclusion: Regarding the cost, efficacy and easy usage of dydrogestrone, it may be reasonable to use it as an alternative to GnRH antagonist for the prevention of premature LH surge.

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Use of progestins to inhibit spontaneous ovulation during ovarian stimulation: the beginning of a new era?

Abstract: His activity covers the whole field of reproductive medicine and surgery. He is the author of 160 articles in peer-reviewed journals and a recipient of competitively assigned research funds.

Cited by 60 publications

References 52 publications

Comparison of Cumulative Live Birth Rates Between GnRH-A and PPOS in Low-Prognosis Patients According to POSEIDON Criteria: A Cohort Study

Comparison of Cumulative Live Birth Rates Between GnRH-A and PPOS in Low-Prognosis Patients According to POSEIDON Criteria: A Cohort Study

Dydrogesterone‐primed ovarian stimulation is an effective alternative to gonadotropin‐releasing hormone antagonist protocol for freeze‐all cycles in polycystic ovary syndrome

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

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