Effect of Progestin-Primed Ovarian Stimulation Protocol in Infertile Women with Basal Follicle-Stimulating Hormone Levels ≥15 IU/L: A Retrospective Analysis

Abstract

Objective: To evaluate the efficacy of progestin-primed ovarian stimulation (PPOS) protocol in infertile women with high basal follicle-stimulating hormone (FSH) levels ≥15 IU/L. Methods: Patients with high basal FSH levels ≥15 IU/L with autologous oocytes from September 2016 to March 2019 were reviewed. Either medroxyprogesterone acetate 4 mg/d or clomiphene citrate (CC) 50 mg/d was administered daily from day 3 to the trigger day. When serum FSH levels decreased to ≤15.0 IU/L, a low dose of human menopausal gonadotropin (hMG) 75/150 IU/d was administered to promote late follicular development. Results: Two hundred and twenty women were retrospectively analyzed in this study. Among them, 139 patients were administered with PPOS protocol as the study group, and 81 patients were administered with CC protocol as the control group. The numbers of received oocytes and viable embryos were higher in the study group than those in the control group (1.5 ± 1.2 vs. 1.2 ± 0.8 and 0.8 ± 0.8 vs. 0.5 ± 0.6, respectively, P < 0.05). However, hMG duration and dosage were significantly higher in the study group than those in the control group (4.2 ± 2.7 d vs. 1.1 ± 2.3 d and 609.1 ± 424.5 IU vs. 140.7 ± 231.3 IU, respectively, P < 0.01). Incidence of luteinizing hormone surge and cycle cancellation rate were lower in the study group than those in the control group with statistical difference (2.88% vs. 16.05% and 36.50% vs. 50.63%, respectively, P < 0.05). Conclusions: PPOS protocol can effectively downregulate the endogenous FSH levels. Compared with CC protocol, treatment with PPOS protocol in patients with high basal FSH levels ≥15 IU/L could receive more oocytes and more viable embryos.