Abstract
Objective: Progestin was recently used as an alternative of gonadotropin-releasing hormone (GnRH) analog for preventing premature luteinizing hormone (LH) surge with the aid of vitrification techniques, however, limited data were available about the potential of progestin in poor responders undergoing in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) treatment. We performed a randomized parallel controlled trial to investigate the difference of progestin and GnRH antagonist in poor responders.Methods: A total of 340 poor responders who met with Bologna criteria were randomly allocated into the progestin-primed ovarian stimulation (PPOS) group and GnRH antagonist group. Fresh embryo transfer was preferred in the GnRH antagonist group and freeze-all was performed in the PPOS group. The primary outcome was the incidence of premature LH surge, secondary outcomes were the number of retrieved oocytes, the number of viable embryos and the pregnancy outcomes.Results: The results showed that the incidence of premature LH surge in PPOS group was lower than that in antagonist group (0 vs. 5.88%, P < 0.05). In PPOS group, the average numbers of oocytes and viable embryos were comparable to those in GnRH antagonist group (3.7 ± 2.6 vs. 3.4 ± 2.4; 1.6 ± 1.7 vs. 1.4 ± 1.3, P > 0.05), the live birth rate was similar between the two groups (21.8 vs. 18.2%, RR 1.25 (95% confidence interval 0.73, 2.13), P > 0.05).Conclusions: The study demonstrated that PPOS had a more robust control for preventing premature LH rise than GnRH antagonist in poor responders, but PPOS in combination with freeze-all did not significantly increase the probability of pregnancy than GnRH antagonist protocol for poor responders.
Highlights
METHODSSince the beginning of ovarian stimulation for in vitro fertilization (IVF), the management of poor ovarian response has been a baffling riddle for clinicians [1]
Gonadotropin-releasing hormone (GnRH) antagonist has been used to suppress pituitary activity and prevent premature luteinizing hormone (LH) surges during controlled ovarian stimulation since 1990s [7, 8], and it is beneficial for the poor responders due to its advantage of less suppression in the early follicular phase [9,10,11]
A total of 340 women were randomly assigned to GnRH antagonist group or progestin-primed ovarian stimulation (PPOS) group, with 170 participants in each group
Summary
METHODSSince the beginning of ovarian stimulation for in vitro fertilization (IVF), the management of poor ovarian response has been a baffling riddle for clinicians [1]. How to control the premature luteinizing hormone (LH) surge and premature ovulation in poor responders has long being an issue in IVF treatment [6]. Gonadotropin-releasing hormone (GnRH) antagonist has been used to suppress pituitary activity and prevent premature LH surges during controlled ovarian stimulation since 1990s [7, 8], and it is beneficial for the poor responders due to its advantage of less suppression in the early follicular phase [9,10,11]. GnRH antagonist is reported about 0.34–8.0% failure to control premature LH surge in ovulatory women, the predominant risk factors of GnRH antagonist failure include the increased age, diminished ovarian reserve (DOR) and poor response to gonadotropin [12,13,14,15,16]
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