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Comparison of progesterone protocol versus gonadotropin-releasing hormone antagonist protocol in terms of preventing premature LH surge and assisted reproductive technology outcome in infertile women: a randomized controlled trial

  • General Gynecology
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Abstract

Introduction

Progesterone can be used instead of GnRH agonists and antagonists in order to avert a premature LH surge during controlled ovarian stimulation (COS) protocol. Nonetheless, there is limited knowledge regarding its utilization. Thus, this study compared the effects of progesterone and GnRH antagonists (GnRH-ant) on premature LH surges and assisted reproductive technology (ART) results in infertile women undergoing ART.

Materials and methods

In this clinical trial, the progesterone protocol (study group) and GnRH-ant protocol (control group) were tested in 300 infertile individuals undergoing IVF/ICSI. The main outcome was the number of oocytes retrieved. The secondary outcomes included premature LH rise/surge, the quantity of follicles measuring ≥ 10 and 14 mm, oocyte maturity and fertilization rate, the number of viable embryos, high-quality embryo rate and pregnancy outcomes.

Results

The study group exhibited a statistically significant increase in the number of retrieved oocytes, follicles measuring 14 mm or greater, and viable embryos compared to the control group (P < 0.05). The study group also increased oocyte maturity, chemical pregnancy rate, and clinical pregnancy rate (P < 0.05). Both groups had similar mean serum LH, progesterone, and E2 levels on trigger day. The control group had more premature LH rise than the study group, although this difference was not statistically significant.

Conclusion

In conclusion, it can be stated that the progesterone protocol and the GnRH-ant protocol exhibit similar rates of sudden premature LH surge in infertile patients. However, it is important to note that the two regiments differ in their outcomes in ART.

Trial registration

This study was retrospectively registered in the Iranian website (www.irct.ir) for clinical trials registration (http://www.irct.ir: IRCT-ID: IRCT20201029049183N, 2020-11-27).

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Availability of data and materials

The datasets used and analyzed during the present study are available from the corresponding author on reasonable request.

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Acknowledgements

We are grateful to the staff at Shariati Hospital for their careful clinical work and accurate data gathering regarding the instances described in this study.

Funding

This study was financially supported by the Tehran University of Medical Sciences, Tehran, Iran.

Author information

Author notes

  1. Masoome Jabarpour and Sara Pouri contributed equally to this work and share first authorship.

Authors and Affiliations

  1. Department of Anatomy, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran

    Masoome Jabarpour & Maryam Shabani Nashtaei

  2. Department of Obstetrics and Gynecology, Shariati Hospital, Tehran University of Medical Sciences, Jalal-e-Al-e-Ahmad Hwy, Tehran, 1411713135, Iran

    Sara Pouri, Ashraf Aleyasin & Aida Najafian

  3. Department of Infertility, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran

    Ashraf Aleyasin, Maryam Shabani Nashtaei & Aida Najafian

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  1. Masoome Jabarpour
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  4. Maryam Shabani Nashtaei
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Contributions

AN and AA developed the idea for the project and revised the manuscript; SP, AN, MJ and MSN collected data and performed the data analysis and takes full responsibility for the integrity of the data. MJ drafted the manuscript. The final version has been approved by all authors.

Corresponding author

Correspondence to Aida Najafian.

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Conflict of interest

The authors declare no conflicts of interest.

Ethics approval and consent to participate

The Ethics Committee of Tehran University of Medical Sciences approved the project (Ethics committee reference number: IR.TUMS.MEDICINE.REC.1399.008). Written consent was obtained from all participants.

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Jabarpour, M., Pouri, S., Aleyasin, A. et al. Comparison of progesterone protocol versus gonadotropin-releasing hormone antagonist protocol in terms of preventing premature LH surge and assisted reproductive technology outcome in infertile women: a randomized controlled trial. Arch Gynecol Obstet 309, 1999–2008 (2024). https://doi.org/10.1007/s00404-024-07387-4

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  • DOI: https://doi.org/10.1007/s00404-024-07387-4

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