Different progestin-primed ovarian stimulation protocols in infertile women undergoing in vitro fertilization/intracytoplasmic sperm injection: an analysis of 1188 cycles
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To evaluate the efficacy in suppressing the premature LH surge, embryo quality and pregnancy outcomes of progestin-primed ovarian stimulation (PPOS) protocols using medroxyprogesterone acetate versus utrogestan in women of all ages undergoing in vitro fertilization or intracytoplasmic sperm injection.
1188 patients were enrolled in the retrospective study, of which 1002 patients were treated with medroxyprogesterone acetate (M group) and recombinant follicle-stimulating hormone (r-FSH)simultaneously from day 3 of the cycle until trigger day, while 186 patients were treated with utrogestan (U group) and r-FSH instead. Viable embryos were cryopreserved for later transfer in both groups. Differences in baseline characteristics, ovarian stimulation characteristics, endocrinological characteristics, embryo development and clinical outcome between two groups were assessed. Statistical analyses were performed stratified by age and number of oocytes retrieved.
No significant differences were observed in the baseline characteristics, ovarian stimulation characteristics and clinical outcome of patients between groups. However, blastulation rate in the U group was significantly higher than that in the M group (49.4% vs. 32.9%, P < 0.001). During ovarian stimulation, LH levels remained steady in both groups. Higher percentage of premature LH surge was found in the U group (2.4% vs. 10.2%, P < 0.001), especially for patients aged more than 35 years or who had three oocytes or less retrieved.
Both the administration of medroxyprogesterone acetate and utrogestan in PPOS were sufficient to prevent an untimely LH rise, while for patients with poor ovarian response or aged above 35 years, MPA may result in a more satisfactory LH level. PPOS protocol using medroxyprogesterone acetate or utrogestan was comparable in terms of oocytes and pregnancy outcome, whereas the administration of utrogestan may result in an improved blastulation than medroxyprogesterone acetate, which needs further exploration.
KeywordsProgestin-primed ovarian stimulation (PPOS) Medroxyprogesterone acetate (MPA) Utrogestan Embryo quality Luteinizing hormone surge
YG: project development, data collection, data analysis, manuscript writing. PC: project development, data analysis, manuscript writing. TL: project development, data analysis, manuscript writing. LJ: project development, data analysis, manuscript writing. PS: project development, data analysis, manuscript writing. WZ: data collection, data analysis. CD:data collection, data analysis. CF: project development, manuscript writing tutor. XL: project development.
This study was supported by the National Natural Science Foundation of China (Grant number 81871214) and National Key R&D Program of China (Grant number 2017YFC1001603).
Compliance with ethical standards
Conflict of interest
The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.
This study was approved by the Institutional Reviewer Board of Sixth Affiliated Hospital of Sun Yat-sen University.
Research involving human participants and/or animals
For this type of study formal consent is not required. This article does not contain any studies with human participants or animals performed by any of the authors.
Because of the retrospective nature of the study the requirement of informed patient consent was waived.
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