The Review of Compared Progestins Type and Dose Utility against the Pituitary Suppression during Ovarian Stimulation for Assisted Reproductive Technology

Alexandru Polexa 1 , 2 , Sebile Guler Cekic 2 , Sule Yildiz 2 , Engin Turkgeldi 2 ,  and Baris Ata 2
  • 1 “George Emil Palade” University of Medicine, Pharmacy, Science and Technology, , Tg. Mureş
  • 2 Koc University Hospital, , Istanbul, Turkey

Abstract

We performed a literature review of studies comparing the effectiveness of progestins in preventing premature ovulation during ovarian stimulation for assisted reproductive technology (ART). Five randomized trials and cohort studies involving a total of 2404 women, which compared; i) two different progestins or ii) two different doses of the same progestin were included. The primary outcome was live birth rate (LBR) per woman. Secondary outcomes were live birth or ongoing pregnancy (LB/OP) per woman and per embryo transfer (ET), ongoing pregnancy, clinical pregnancy, positive pregnancy test, numbers of oocytes and metaphase-two oocytes, duration of stimulation and gonadotropin consumption. The primary outcome was not reported in most studies however there were no differences between progestins for secondary outcomes. All progestins seem to effectively prevent premature ovulation in ART cycles. Low-quality evidence suggests that progestins can effectively prevent premature ovulation in ART cycles.

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  • 1. Al-Inany HG, Youssef MA, Ayeleke RO, Brown J, Lam WS, Broekmans FJ. Gonadotrophin-releasing hormone antagonists for assisted reproductive technology. Cochrane Database Syst Rev. 2016;4, p CD001750. doi:10.1002/14651858.CD001750.pub4 Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/27126581.

  • 2. Dong J, Wang Y, Chai WR, Hong QQ, Wang NL, Sun LH, Kuang HP. The pregnancy outcome of progestin-primed ovarian stimulation using 4 versus 10 mg of medroxyprogesterone acetate per day in infertile women undergoing in vitro fertilisation: a randomised controlled trial. BJOG. 2017;124(7):1048-1055. doi:10.1111/1471-0528.14622 Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/28276192.

  • 3. Ubaldi FM, Capalbo A, Vaiarelli A, Cimadomo D, Colamaria S, Alviggi C, Rienzi L. Follicular versus luteal phase ovarian stimulation during the same menstrual cycle (DuoStim) in a reduced ovarian reserve population results in a similar euploid blastocyst formation rate: new insight in ovarian reserve exploitation. Fertil Steril. 2016;105(6):1488-1495 e1481. doi:10.1016/j.fertnstert.2016.03.002 Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/27020168.

  • 4. Zhu X, Ye H, Fu Y. The Utrogestan and hMG protocol in patients with polycystic ovarian syndrome undergoing controlled ovarian hyperstimulation during IVF/ICSI treatments. Medicine (Baltimore. 2016;95(28):e4193. doi:10.1097/MD.0000000000004193 Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/27428219.

  • 5. Zhu X, Ye H, Fu Y. Comparison of neonatal outcomes following progesterone use during ovarian stimulation with frozen-thawed embryo transfer. Sci Rep. 2017;7(1):7835. doi:10.1038/s41598-017-08472-2 Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/28798414.

  • 6. Yildiz S, Turkgeldi E, Angun B, Eraslan A, Urman B, Ata, B. Comparison of a novel flexible progestin primed ovarian stimulation protocol and the flexible gonadotropin-releasing hormone antagonist protocol for assisted reproductive technology. Fertil Steril. 2019;112(4):677-683. doi:10.1016/j.fertnstert.2019.06.009 Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/31371053.

  • 7. Zhu X, Ye H, Fu Y. Duphaston and human menopausal gonadotropin protocol in normally ovulatory women undergoing controlled ovarian hyperstimulation during in vitro fertilization/intracytoplasmic sperm injection treatments in combination with embryo cryopreservation. Fertil Steri. 2017;108(3):505-512 e502. doi:10.1016/j.fertnstert.2017.06.017 Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/28697910.

  • 8. Guo YC, Chen PY, Li TT, Jia L, Sun P, Zhu WS. Liang X. Y. Different progestin-primed ovarian stimulation protocols in infertile women undergoing in vitro fertilization/intracytoplasmic sperm injection: an analysis of 1188 cycles. Arch Gynecol Obstet. 2019;299(4):1201-1212. doi:10.1007/s00404-019-05065-4 Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/30852654.

  • 9. Yu S, Long H, Chang HY, Liu Y, Gao H, Zhu J, Ai A. New application of dydrogesterone as a part of a progestin-primed ovarian stimulation protocol for IVF: a randomized controlled trial including 516 first IVF/ICSI cycles. Hum Reprod. 2018;33(2):229-237. doi:10.1093/humrep/dex367 Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/29300975.

  • 10. Zhu X, Ye H, Fu Y. Use of Utrogestan during controlled ovarian hyperstimulation in normally ovulating women undergoing in vitro fertilization or intracytoplasmic sperm injection treatments in combination with a “freeze all” strategy: a randomized controlled dose-finding study of 100 mg versus 200 mg. Fertil Steril. 2017;107(2):379-386 e374. doi:10.1016/j.fertnstert.2016.10.030 Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/27865446.

  • 11. Evans MB, Parikh T, DeCherney AH, Csokmay JM, Healy, MW, Hill MJ. Evaluation of the cost-effectiveness of ovulation suppression with progestins compared with GnRH analogs in assisted reproduction cycles. Reprod Biomed Online. 2019;38(5):691-698. doi:10.1016/j.rbmo.2018.12.044 Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/30926176.

  • 12. Iwami N, Kawamata M, Ozawa N, Yamamoto T, Watanabe E, Moriwaka O, Kamiya H. (2018). New trial of progestin-primed ovarian stimulation using dydrogesterone versus a typical GnRH antagonist regimen in assisted reproductive technology. Arch Gynecol Obstet. 2018;298(3):663-671. doi:10.1007/s00404-018-4856-8 Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/30069600.

  • 13. La Marca A, Capuzzo M. Use of progestins to inhibit spontaneous ovulation during ovarian stimulation: the beginning of a new era? Reprod Biomed Online. 2019;39(2):321-331. doi:10.1016/j.rbmo.2019.03.212 Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/31138494.

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