A meta-analysis of the efficacy of progestin-primed ovarian stimulation with medroxyprogesterone acetate in ovulation induction in poor ovarian responders

Cai, Ruihong; Zheng, Baodong; Lin, Qiupin; Deng, Jiehui; Zeng, Xiaoping; Lin, Wei Chun; Shi, Daohua

doi:10.1016/j.jogoh.2020.102049

Cited by 14 publications

(6 citation statements)

References 3 publications

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“…The new ovarian stimulation regimen, PPOS, has gained increasing use, and a number of clinical studies have demonstrated its value for POR patients. PPOS has been widely applied in clinical，a recent meta-analysis showed that PPOS reduces the need for cycle cancellation, increases the quality of follicles and embryos, improves the pregnancy rate, and thus presents an effective option for IVF-ET in patients with POR (11). In a clinical study of 117 aged women with POR, Mu et al (12) also found that the number of follicles, the number of eggs, clinical pregnancy, and live birth rates in the PPOS group were significantly superior to those in the ultrashort protocol group.…”

Section: With the Rapid Socioeconomic Development And Thementioning

confidence: 99%

Efficacy of progestin-primed ovarian stimulation (PPOS) versus minimal stimulation in women of advanced maternal age with poor ovarian response under the Patient-Oriented Strategies Encompassing Individualized Oocyte Number (POSEIDON) criteria

Zhao

Wang

2023

Ann Palliat Med

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Background: We investigated the efficacy of progestin-primed ovarian stimulation (PPOS) and minimal stimulation using clomiphene citrate (CC) + gonadotropin (Gn) for in-vitro fertilization-embryo transfer (IVF-ET) in advanced maternal age (AMA) women with poor ovarian response (POR) according to the Patient-Oriented Strategies Encompassing Individualized Oocyte Number (POSEIDON) criteria.Methods: A retrospective analysis was performed using the data of AMA patients who had received IVF-ET due to a low ovarian reserve. The enrolled patients were screened according to the POSEIDON group 4 criteria. 102 patients were included in the study, including 52 in the PPOS group and 50 in the minimal stimulation group (who received CC + Gn). The duration of Gn administration, Gn dose, estradiol (E2), and luteinizing hormone (LH) levels on the day of trigger, the cancellation rate of the oocyte retrieval cycle, the number of oocytes retrieved, the number of metaphase II (MII) oocytes, and IVF laboratory outcomes during ovarian stimulation were compared between the 2 groups.Results: No significant differences were found in terms of age, infertility, body mass index (BMI), and basal follicle-stimulating hormone, LH, E2, AFC, and AMH between the 2 groups (all P>0.05). The duration of ovarian stimulation [(9.43±2.44) vs. (7.48±3.09) days, P<0.05] was significantly longer and the total Gn dose [(2,423.22±738.66) vs. (1,579.68±728.86) IU, P<0.05] were significantly higher in the PPOS group than the minimal stimulation group. The LH value on the day of trigger in the PPOS group (3.28 mIU/mL) was significantly lower than that in the minimal stimulation group (5.57 mIU/mL) (P<0.05). The number of oocytes retrieved, normal fertilization rate, number of good-quality embryos on day 3, number of transferable embryos, and number of frozen blastocysts did not differ significantly between the 2 groups (all P>0.05). The proportion of MII oocytes was significantly higher in the PPOS group than the minimal stimulation group (94.05% vs. 81.40%, P<0.05).Conclusions: For patients in the POSEIDON group 4, PPOS effectively blocked the premature LH surge and increased the proportion of mature oocytes. Thus, it is a feasible ovulation stimulation protocol for AMA women with POR.

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Section: With the Rapid Socioeconomic Development And Thementioning

confidence: 99%

Efficacy of progestin-primed ovarian stimulation (PPOS) versus minimal stimulation in women of advanced maternal age with poor ovarian response under the Patient-Oriented Strategies Encompassing Individualized Oocyte Number (POSEIDON) criteria

Zhao

Wang

2023

Ann Palliat Med

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“…Interesting data suggest that in the PPOS cycle, the progestin metabolites, including androgens, Fertility, IVF and reproductive genetics may promote the proliferation of the granulosa cells in patients with low ovarian response, stimulating follicular growth and maturation and improving oocyte and embryo quality [53]. However, a metaanalysis suggested that the PPOS protocol using MPA in low ovarian response patients may result in a higher mature-oocyte number and quality, fewer cycle cancellations, and a higher cumulative rate of pregnancies compared with other protocols.…”

Section: Progestin-primed Ovarian Stimulation In the Double Stimulati...mentioning

confidence: 99%

Double stimulation for the management of poor-prognosis patients: where are we going?

Petrone

Vaiarelli

Blockeel

2023

Current Opinion in Obstetrics &Amp; Gynecology

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Purpose of reviewThe technical improvements in IVF allowed the implementation of nonconventional ovarian stimulation protocols for some specific patients. Where time is crucial, such as with oncologic patients, poor-prognosis patients, patients with low ovarian reserve, and those with advanced maternal age, access to IVF treatment is even more critical. Some of these protocols might start in the late follicular phase, luteal phase, or involve both stimulations within the same ovarian cycle.Recent findingsUntil now, published evidence showed that oocytes retrieved from unconventional protocol seem to be developmentally, genetically, and reproductively competent. Second stimulation in the same ovarian cycle after the conventional approach may represent a sound alternative to oocyte accumulation. This can be proposed in progress after careful counselling focused on the patients’ chances of finding at least one euploid embryo on account of their age and of the number of blastocysts obtained after the conventional approach.SummaryThe adoption of these new strategies, known as double stimulation protocol, can be conceived as a real full-personalization of ovarian stimulation. Multicentre prospective RCTs are urgently needed to evaluate the efficacy, efficiency, and costs of double stimulation versus two consecutive conventional approaches with standard or mild stimulation and in a different IVF setting.

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“…Compared conventional COH protocols, the PPOS prevents premature LH surge by supplying with small doses of progesterone [19,20] . A meta-analysis showed that for patients with poor ovarian response, the use of PPOS can improve follicles, embryos, and the pregnancy rate [21] . In the present case, 13 oocytes were retrieved and 4 embryos were frozen.…”

Section: Progestin-primed Ovarian Protocolmentioning

confidence: 99%

A Successful Live Birth Through In Vitro Fertilization and Embryo Transfer in Stage IVb Endometrial Carcinoma after Conservative Treatment: a Case Report

Xiao,

Song,

Zhao

et al. 2023

Preprint

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Introduction An increasing number of young patients with early-stage endometrial cancer are opting for fertility-sparing treatment, and they have achieved reassuring rates of complete remission, with some women achieving pregnancy. However, surgical treatment is still recommended for patients with advanced endometrial cancer. We reported a woman with IVb endometrial cancer (EC) who reached complete remission (CR) and gained a live birth successfully with the help of in vitro fertilization and embryo transfer (IVF-ET). Case report A 30-year-old woman found to have stage IVb EC after hysteroscopy, laparoscopy, and pathological examination. After a combination of chemotherapy and progesterone therapy, the woman achieved complete remission. The woman became pregnant with IVF-ET and got a full-term live birth. In addition, there was no recurrence after 19 months of observation. The molecular classification of POLE and the combination of chemotherapy and progesterone therapy may be associated with a good prognosis of this patient. The use of progestin-primed ovarian stimulation (PPOS) and the combination of letrozole and levonorgestrel-releasing intrauterine device (LNG-IUD) during ovulation induction seemed to be safe for the woman Conclusion This is the first report on fertility-sparing treatment and live birth for advanced EC. IVF-ET is feasible for women with EC who preserve reproductive function. The progestin-primed ovarian stimulation combined with levonorgestrel-releasing intrauterine device and letrozole seems to be safe for these women. Patients still need to be closely watched for tumor recurrence.

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A meta-analysis of the efficacy of progestin-primed ovarian stimulation with medroxyprogesterone acetate in ovulation induction in poor ovarian responders

Cited by 14 publications

References 3 publications

Efficacy of progestin-primed ovarian stimulation (PPOS) versus minimal stimulation in women of advanced maternal age with poor ovarian response under the Patient-Oriented Strategies Encompassing Individualized Oocyte Number (POSEIDON) criteria

Efficacy of progestin-primed ovarian stimulation (PPOS) versus minimal stimulation in women of advanced maternal age with poor ovarian response under the Patient-Oriented Strategies Encompassing Individualized Oocyte Number (POSEIDON) criteria

Double stimulation for the management of poor-prognosis patients: where are we going?

A Successful Live Birth Through In Vitro Fertilization and Embryo Transfer in Stage IVb Endometrial Carcinoma after Conservative Treatment: a Case Report

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