Chapter 12 - The use of progestins to prevent the LH surge in IVF cycles

Abstract

Advances in cryopreservation techniques for oocytes and embryos have permitted new approaches in the field of ovarian stimulation. Progesterone and its derivatives have been proposed to inhibit ovulation in in vitro fertilization cycles, as oocyte vitrification removes possible harmful effects of progestins on endometrial receptivity. Progestin-primed ovarian stimulation has been shown to be effective when compared with conventional stimulation in inhibiting spontaneous ovulation, without affecting the number of retrieved oocytes and embryo quality. Reproductive outcomes from ovarian stimulation with progestins appear similar to those from conventional ovarian stimulation, although large trials are needed to confirm this. The use of progestins allows moreover lower costs and easier administration since they can be taken orally. Progestin-primed ovarian stimulation could be the first choice for ovarian stimulation in predicted hyper-responders, patients who undergo fertility preservation for medical and nonmedical reasons, preimplantation genetic testing, and oocyte donors, when freeze-all strategy is mandatory.