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. (June 2017)

• Record Type: Journal Article
• Authors: Dong, J; Wang, Y; Chai, WR; Hong, QQ; Wang, NL; Sun, LH; Long, H; Wang, L; Tian, H; Lyu, QF; Lu, XF; Chen, QJ; Kuang, YP
• Is Part Of: BJOG. Volume 124:Number 7(2017)
• Page Start: 1048
• Page End: 1055
• Publication Date: 2017-06
• Subjects: Controlled ovarian stimulation -- luteinising hormone surge -- progestin; Obstetrics -- Periodicals; Gynecology -- Periodicals; 618
• DOI: 10.1111/1471-0528.14622
• Languages: English
• ISSNs: 1470-0328

Abstract

Abstract : Objective: To investigate the clinical outcome and endocrinological characteristics of progestin‐primed ovarian stimulation (PPOS) using 4 versus 10 mg of medroxyprogesterone acetate (MPA) per day in infertile women with normal ovary reserve. Design: A randomised parallel controlled trial. Setting: Tertiary‐care academic medical centre. Participants: A cohort of 300 infertile women undergoing in vitro fertilisation (IVF)/intracytoplasmic sperm injection (ICSI) treatment. Methods: Human menopausal gonadotropin (hMG; 225 iu per day) and MPA (group A, 10 mg per day; group B, 4 mg per day) were started simultaneously from cycle day 3 onwards. Ovulation was co‐triggered by human chorionic gonadotropin (hCG; 1000 iu) and gonadotropin‐releasing hormone agonist (GnRH agonist; 0.1 mg) when dominant follicles matured. Viable embryos were cryopreserved for later frozen embryo transfer (FET) in both groups. Main outcome measures: The primary outcome measure was the number of oocytes retrieved. Secondary outcomes included the incidence of a premature surge in luteinising hormone (LH), the number of viable embryos, and clinical pregnancy outcomes. Results: The number of oocytes retrieved and viable embryos were similar between two groups (9.8 ± 6.3 versus 9.6 ± 5.9; 4.2 ± 2.6 versus 3.7 ± 3.0; P > 0.05). No significant difference was found in clinical pregnancy rate (58.0 versus 48.7%) and live birth rate per participant (48.7 versus 42.0%; P > 0.05). No premature LH surge and ovarian hyperstimulation syndrome (OHSS) occurred in either group. Conclusions: Progestin‐primed ovarian stimulation (PPOS) using 4 or 10 mg of MPA per day was comparable in terms of the number of oocytes retrieved and pregnancy outcome after FET. The administration of 4 mg of MPA per day was sufficient to prevent an untimely LH rise in women undergoing IVF/ICSI treatment. Tweetable abstract: An RCT confirmed similar pregnancy outcome in P‐primed ovarian stimulation with a daily dose of 4 or 10 mg MPA. Tweetable abstract: An RCT confirmed similar pregnancy outcome in P‐primed ovarian stimulation with a daily dose of 4 or 10 mg MPA.