Progestin‐primed ovarian stimulation with or without clomiphene citrate supplementation in normal ovulatory women undergoing in vitro fertilization/intracytoplasmic sperm injection: A prospective randomized controlled trial. (4th January 2018)

• Record Type: Journal Article
• Authors: Liu, Yali; Chen, Qiuju; Yu, Sha; Wang, Yun; He, Wen; Chang, Hannah Ya‐Ning; Wang, Bian; Gao, Hongyuan; Long, Hui; Wang, Li; Lyu, Qifeng; Ai, Ai; Kuang, Yanping
• Is Part Of: Clinical endocrinology. Volume 88:Number 3(2018)
• Page Start: 442
• Page End: 452
• Publication Date: 2018-01-04
• Subjects: clomiphene citrate -- medroxyprogesterone acetate -- premature LH surge -- progestin‐primed ovarian stimulation; Endocrinology -- Periodicals; 616.4005
• DOI: 10.1111/cen.13532
• Languages: English
• ISSNs: 0300-0664

Abstract

Summary: Objective: To compare the endocrinological profiles, cycle characteristics and pregnancy outcomes of progestin‐primed ovarian stimulation (PPOS) with or without clomiphene citrate (CC) supplementation in normal ovulatory women undergoing in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI). Design: Prospective randomized controlled study. Patient(s): A total of 320 infertile women undergoing IVF/ICSI. Medroxyprogesterone acetate (MPA) and human menopausal gonadotropin (hMG) were simultaneously administered on menstrual cycle day 3. The women were randomized into 2 equal groups with or without CC supplementation. Measures: The primary outcome measure was the percentage of women with profound pituitary suppression (luteinizing hormone [LH] <1.0 IU/L on the trigger day). The secondary outcomes were endocrinological profiles, cycle characteristics and pregnancy outcomes. Results: The percentage of women with profound pituitary suppression was significantly lower in the study group (hMG + MPA + CC) than in the control group (hMG + MPA) (1.9% vs 33.1%, P < .001). The mean LH level during controlled ovarian stimulation (COS) was higher in the study group than in the control group ( P < .001), but none of the patients in either group exhibited a premature LH surge. The doses of Gn in the study group were significantly lower than those in the control group (1334.06 ± 212.53 IU vs 1488.28 ± 325.08 IU, P < .001). The number of oocytes retrieved was similar between the 2 groups (10.03 ± 5.97 vs 10.34 ± 7.52, P > .05). No significant differences were observed in either the number of viable embryos or the pregnancy outcomes between the 2 groups. Conclusion(s): Clomiphene citrate is an effective adjuvant to alleviate pituitary suppression in the PPOS protocol; however, it has no impact on clinical outcomes.