An extremely patient-friendly and efficient stimulation protocol for assisted reproductive technology in normal and high responders

Huang, Chen‐Yu; Chen, Guan-Yeu; Shieh, Miawh-Lirng; Li, Hsin-Yang

doi:10.1186/s12958-018-0335-0

Cited by 28 publications

(20 citation statements)

References 37 publications

(32 reference statements)

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“…In order to inhibit LH increasing, progestin-primed ovarian stimulation (PPOS) was stated.I In this protocol oral progesterone (P) injected from the initial day of ovarian stimulation at the follicular phase (4). Using this novel PPOS protocol, P level, are utilized as the substitutions of GnRH analogue to inhibit the early LH surge during the follicular stage (5).…”

Section: Introductionmentioning

confidence: 99%

Progesterone- primed ovarian stimulation in polycystic ovarian syndrome: An RCT

Eftekhar¹,

Hoseini²,

Saeed³

2019

IJRM

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Background: In vitro fertilization is an important therapy for women with polycystic ovarian syndrome (PCOS). The use of new ways of improving clinical results is yet required. Objective: This study was aimed to investigate the efficacy of progesterone primed ovarian stimulation (PPOS) and compare with conventional antagonist protocol in PCOS. Materials and Methods: A total of 120 PCOS women who were candidates for assisted reproductive technology treatment from August to January 2019 were enrolled in this RCT and were placed into two groups, randomly (n = 60/each). The PPOS group received 20 mg/day Dydrogesterone orally since the second day of the cycle and the control group received antagonist protocol. The pregnancy outcomes including the chemical and clinical pregnancy, the miscarriage rate, and the percent of gestational sacs/transferred embryos was compared in two groups. Results: Number of MII oocyte, maturity rate, Number of 2 pronuclei (2PN) and serum estradiol levels on trigger day were statistically lower in PPOS group (p = 0.019, p = 0.035, p = 0.032, p = 0.030), respectively. Serum LH level on trigger day in PPOS group was higher than antagonist group (p = 0.005). Although there wasn’t sever ovarian hyper simulation syndrome in any participants, mild and moderate ovarian hyper simulation syndrome was less in PPOS group (p = 0.001). Also, the chemical and clinical pregnancy rate were higher in the antagonist group, althoughit was not statistically significant (p = 0.136, p = 0.093 respectively). Conclusion: Our study demonstrate that PPOS does not improve chemical and clinical pregnancy rate of the infertile women with PCOS. Key words: Progesterone, Polycystic ovarian syndrome, Controlled ovarian stimulation, Frozen-thawed embryo transfer, Pregnancy rate.

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Section: Introductionmentioning

confidence: 99%

Progesterone- primed ovarian stimulation in polycystic ovarian syndrome: An RCT

Eftekhar¹,

Hoseini²,

Saeed³

2019

IJRM

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“…Several reports have studied the use of PPOS protocols for in vitro fertilization (IVF) procedures for women with endometriosis-associated infertility and found them to be more effective than other stimulation protocols [12,[21][22][23][24][25][26]. Indeed, a PPOS protocol has several advantages.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of fertility preservation in women with endometriosis: comparison of progestin-primed ovarian stimulation versus antagonist protocols

et al. 2020

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Background: PPOS protocols, initially described for FP in women with cancer, have many advantages compared to antagonist protocols. PPOS protocols were not evaluated for women with endometriosis. The objective of the study was to describe fertility preservation outcomes in women with endometriosis and to compare an antagonist protocol with a Progestin-Primed Ovarian Stimulation (PPOS) protocol. Method: We conducted a prospective cohort study associated with a cost-effectiveness analysis in a tertiary-care university hospital. The measured outcomes included the numbers of retrieved and vitrified oocytes, and direct medical costs. In the whole population, unique and multiple linear regressions analysis were performed to search for a correlation between individual characteristics and the number of retrieved oocyte. Results: We included 108 women with endometriosis who had a single stimulation cycle performed with either an antagonist or a PPOS protocol. Overall, 8.1 ± 6.6 oocytes were retrieved and 6.4 ± 5.6 oocytes vitrified per patient. In the multiple regression model, age (p = 0.001), prior ovarian surgery (p = 0.035), and anti-Mullerian hormone level (p = 0.001) were associated with the number of retrieved oocytes. Fifty-four women were stimulated with an antagonist protocol, and 54 with a PPOS protocol. A mean of 7.9 ± 7.4 oocytes were retrieved in the antagonist group and 8.2 ± 5.6 in the PPOS group (p = 0.78). A mean of 6.4 ± 6.4 oocytes were vitrified in the antagonist group and 6.4 ± 4.7 in the PPOS group (p = 1). In the cost-effectiveness analysis, the PPOS protocol was strongly dominant over the antagonist protocol. Conclusion: Fertility preservation procedures are feasible and effective for patients affected by endometriosis. Antagonist and PPOS protocols were associated with similar results but the medico-economic analysis was in favor of PPOS protocols.

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“…Ethical approval for this study was obtained from the Institutional Review Board of Taipei Veterans General Hospital (2018-12-005BC) Treatment protocol of ovarian stimulation and oocyte retrieval Transvaginal ultrasound and serum hormone measurements (FSH, LH, estradiol [E2], and progesterone [P]) were performed on the starting day just before long-acting FSH (corifollitropin alfa) injection, of which the dosage was determined by the patient's body weight (150 micrograms for > 60 kg and 100 micrograms for ≤ 60 kg [16]). In cycles with PPOS (PPOS protocol, group 1), patients took medroxyprogesterone acetate (MPA) 5 mg BID from the day after long-acting FSH injection, which was published elsewhere [14]. In cycles with antagonist protocol (antagonist protocol, group 2), daily cetrorelix 0.25 mg subcutaneous (sc) injection was initiated from the evening of stimulation day 5.…”

Section: Materials and Methods Study Setting And Patientsmentioning

confidence: 99%

“…To pursue a more patient-friendly way of ovarian stimulation in ART cycles, we combined PPOS with long-acting follicle stimulation hormone (FSH), corifollitropin alfa, and demonstrated a competent reproductive outcome in normal/high responders with cumulative ongoing pregnancy rate per oocyte retrieval of 53.1%. In the aforementioned PPOS using long-acting FSH, only 3.6 injections shots and 1.4 visits were needed on average before trigger [14]. According to a worldwide survey of ART practices, more than three-quarters of cycles utilized an antagonist protocol [15]; however, researches seldom focused on the comparison between PPOS and antagonist protocol.…”

Section: Introductionmentioning

confidence: 99%

Validation of an extremely patient-friendly progestin-primed ovarian stimulation protocol in normal and high responders by comparing with conventional antagonist protocol: a retrospective study

Huang

Chen

Shieh

et al. 2020

Preprint

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Background. Our previous study has shown a satisfactory reproductive outcome resulting from the extremely patient-friendly ovarian stimulation protocol of long-acting follicle stimulation hormone (FSH) plus oral medroxyprogesterone acetate (MPA). The present study was aimed to compare the efficacy of the extremely patient-friendly ovarian stimulation protocol with that of antagonist protocol.Methods. A retrospective study was conducted on normal and high responders aged from 24 to 39 years starting ovarian stimulation for IVF/ICSI with long-acting FSH at early follicular phase in a tertiary fertility center in Taiwan between December 2016 and August 2017. To prevent premature luteinizing hormone (LH) surge, oral MPA was applied in some cycles (group 1), whereas antagonist protocol was applied in other cycles (group 2). Freezing all embryos was applied to all patients in both groups. Duration of stimulation, number of shots and visits before trigger, incidence of premature LH surge, number of oocytes retrieved, fertilization rate, cleavage rate, rate of good embryos available, incidence of ovarian hyperstimulation syndrome, cumulative clinical pregnancy rate, and cumulative live birth rate per retrieval were compared between groups. Results. One hundred and ten cycles of IVF/ICSI were included, among which there were fifty-seven cycles in group 1 and fifty-three cycles in group 2. Starting with long-acting FSH, group 1 (MPA) required much fewer injections and visits but had comparable reproductive outcomes to those in group 2 (antagonist protocol).Conclusions. Long-acting FSH plus MPA use for ovarian stimulation is extremely friendly for the patients and demonstrates satisfactory stimulation and reproductive outcomes that are comparable to those of antagonist protocol.

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An extremely patient-friendly and efficient stimulation protocol for assisted reproductive technology in normal and high responders

Cited by 28 publications

References 37 publications

Progesterone- primed ovarian stimulation in polycystic ovarian syndrome: An RCT

Progesterone- primed ovarian stimulation in polycystic ovarian syndrome: An RCT

Outcomes of fertility preservation in women with endometriosis: comparison of progestin-primed ovarian stimulation versus antagonist protocols

Validation of an extremely patient-friendly progestin-primed ovarian stimulation protocol in normal and high responders by comparing with conventional antagonist protocol: a retrospective study

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