Clomiphene Citrate or Medroxyprogesterone Acetate with Human Menopausal Gonadotropin in Poor Responders during In vitro Fertilization/Intracytoplasmic Sperm Injection Treatments Combined with Embryo Cryopreservation?

Abstract

Objective: This study aimed to compare the efficacy of clomiphene citrate (CC) with human menopausal gonadotropin (hMG) and that of medroxyprogesterone acetate (MPA) with hMG in poor responders defined according to the Bologna criteria. Methods: The data of patients with poor ovarian response (POR) according to the Bologna criteria from September 2016 to November 2017 were retrospectively reviewed. All participants received either CC + hMG or the progesterone-primed ovarian stimulation protocol (PPOS) protocol. Results: A total of 340 patients and 563 in vitro fertilization cycles were analyzed in this study. The incidence of spontaneous luteinizing hormone (LH) surge and the mean LH level on trigger day were significantly lower in the PPOS group than in the CC + HMG group (0.04% vs. 3.49% and 4.26 ± 3.59 vs. 9.38 ± 6.92 mIU/mL, respectively, P < 0.05); however, the incidence of premature ovulation was similar between the two groups. The number of viable embryos harvested was not statistically different between the two groups (1.7 ± 1.1 vs. 1.5 ± 0.8, P = 0.06). The mean dose and duration of hMG were significantly higher in the PPOS group than in the CC + hMG group (908.7 ± 556.6 vs. 177.9 ± 214.5 IU and 6.0 ± 3.4 vs. 1.2 ± 1.5 days, respectively, P < 0.05). However, the number of oocytes retrieved, number of metaphase II oocytes, and fertilization rate were comparable between the two groups. Conclusions: The CC with low-dose gonadotropin strategy was superior to the MPA with hMG protocol for POR.