Abstract
Introduction: A gonadotropin-releasing hormone antagonist is the most common modulator used to prevent the premature luteinizing hormone (LH) surge when ovarian stimulation was initiated in the late follicular phase. We aimed in this study to evaluate the feasibility of performing ovarian stimulation in the late follicular phase without the use of exogenous pituitary modulators.Methods: Data were retrospectively collected from 404 normo-ovulatory patients who underwent their first in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) treatment in our department. One hundred sixteen subjects in the study group received ovarian stimulation when a dominant follicular diameter of ≥ 10 mm was confirmed by transvaginal ultrasonography after menstrual cycle day 6, which entailed a daily injection of gonadotropin until the trigger day, while 288 subjects in the control group received ovarian stimulation in the early follicular phase under a progesterone protocol. The primary outcome was the number of mature oocytes.Results: There was no statistical difference in the number of mature oocytes between the two groups (9.67 ± 5.33 in the study group vs. 9.38 ± 5.15 in the control group, P = 0.693). No secondary LH surges in the study group and no premature LH surges in the control group were found during ovarian stimulation. The good-quality embryo rate per oocyte retrieved showed no significant difference between the two groups (35.22 vs. 35.91%, P = 0.665). The clinical pregnancy rate per transfer was 54.55% in the study group and 56.48% in the control group (P = 0.718), and the implantation rate was similar between the two groups (36.94 vs. 37.77%, P = 0.829).Conclusions: Our study revealed that late follicular phase ovarian stimulation could be performed without an exogenous pituitary modulator.
Highlights
A gonadotropin-releasing hormone antagonist is the most common modulator used to prevent the premature luteinizing hormone (LH) surge when ovarian stimulation was initiated in the late follicular phase
The reduction in the risk of ovarian hyperstimulation syndrome (OHSS) with frozenembryo transfer (FET) has been confirmed among ovulatory women with infertility, investigators have not found a statistical difference in the live-birth rate between FET and fresh-embryo transfers [3]
We uncovered no statistical differences between the two groups in age, body mass index (BMI), duration of infertility, or basal serum hormone levels
Summary
A gonadotropin-releasing hormone antagonist is the most common modulator used to prevent the premature luteinizing hormone (LH) surge when ovarian stimulation was initiated in the late follicular phase. Fresh-embryo transfer was once routine practice in the years before in vitro fertilization (IVF); its disadvantages included a high risk of ovarian hyperstimulation syndrome (OHSS) and the potentially detrimental effects of supraphysiologic hormone levels on endometrial receptivity. These adverse consequences have inspired experts to explore other strategies for improving the. The reduction in the risk of OHSS with FET has been confirmed among ovulatory women with infertility, investigators have not found a statistical difference in the live-birth rate between FET and fresh-embryo transfers [3]. The proportion of FET cycles has consistently increased in many countries
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