In Vitro Fertilization Results of Gnrh Antagonists and Medroxyprogesterone Acetate Used to Prevent Premature Lh Surge During Ovarian Hyperstimulation

Abstract

Objective The aim of this study was to evaluate the effects of Medroxyprogesterone Acetate (MPA) treatment in comparison to Gonadotropin Releasing Hormone (GnRH) antagonists for the prevention of premature luteinizing hormone (LH) surge during controlled ovarian hyperstimulation (OS) in in vitro fertilization (İVF) treatment, and their impact on developing embryos and pregnancy outcomes. Material and Methods Data from 757 cycles using GnRH antagonists and 756 cycles using MPA were evaluated at Akdeniz University Faculty of Medicine Assisted Reproductive Treatment Center between October 2018 and April 2022. Patient records were obtained from the electronic database of the center and analyzed for demographic data, previous treatment, features of OS treatment, and pregnancy results. All methods in this study were performed in accordance with the relevant guidelines and regulations. Results Patients using MPA were found to be significantly older (33.9 ± 5.6 vs. 32.6 ± 5.6, p < 0.001) and had a lower number of antral follicles (AFC) (10.7 ± 8.6 vs. 11.9 ± 10.8, p = 0.007) than those using GnRH antagonists. Both MPA (2.9%) and GnRH antagonists (2.2%) had similar effectiveness in preventing premature ovulation (p = 0.415). There was no significant difference between the two groups in terms of the number of total developed embryos (1.3 ± 1.3 vs. 1.2 ± 1.2, p = 0.765). The clinical pregnancy rates per embryo transfer (ET) were similar in the first transfers of patients using MPA and GnRH antagonists (%35.4 vs. %30.1, p = 0.074). There was no statistically significant difference between the cumulative clinical pregnancy rates per total transfer of the MPA and GnRH antagonist groups (35.3% vs. 30.1%, p = 0.077). Similarly, no significant difference was observed in the cumulative clinical pregnancy rates per patient treated after all ETs (24.1% vs. 23.2%, p = 0.269). Conclusion MPA was found to be effective in preventing premature ovulation during OS treatment, and the developing embryo and pregnancy outcomes of patients using MPA were similar to those using GnRH antagonists. Therefore, the use of MPA instead of GnRH antagonists during OS may be a viable alternative for patients not scheduled for fresh ET.