Progestins versus GnRH analogues for pituitary suppression during ovarian stimulation for assisted reproductive technology: a systematic review and meta-analysis

Polexa, Alexandru; Cekic, Sebile Guler; Yıldız, Şule; Türkgeldi, Engin; Ata, Barış

doi:10.1016/j.rbmo.2020.01.027

Cited by 23 publications

(11 citation statements)

References 13 publications

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“…The findings of this meta-analysis are referenced for clinicians since controversies have always been raised about the application of PPOS in different populations of patients. Our suggestion of an effective impact of progestins for preventing premature LH surge is consistent with that of a previous meta-analysis ( 26 ) which included three retrospective studies and two prospective studies but only two RCTs. The evidence of that meta-analysis seemed to be of low quality and the results required confirmation by higher quality studies.…”

Section: Discussionsupporting

confidence: 90%

Progestin-Primed Ovarian Stimulation Protocol for Patients in Assisted Reproductive Technology: A Meta-Analysis of Randomized Controlled Trials

et al. 2021

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ObjectivesProgestin-primed ovarian stimulation (PPOS) is a new ovarian stimulation protocol that can block the luteinizing hormone (LH) surge through progesterone instead of traditional down regulating or gonadotropin-releasing hormone (GnRH) antagonist, and in order to achieve multi-follicle recruitment. This paper aims to investigate the effectiveness of PPOS and its suitability for infertile patients with different ovarian reserve functions.MethodsWe searched published randomized controlled trials (RCTs) about PPOS on Cochrane Library, PubMed, Embase, and Web of Science. The search period spanned from January 1, 2015 to November 16, 2020. The data were extracted, and the meta-analysis was performed on ovarian stimulation as well as embryological and clinical outcomes. The outcomes were pooled by a random effects model, and the risk of heterogeneity was evaluated. Subgroup analysis was performed for different ovarian reserve patients.ResultsThe clinical pregnancy rates and live birth or ongoing pregnancy rates with the PPOS protocol were not different from those with the control group. In the diminished ovarian reserve (DOR) subgroup, the PPOS protocol had a lower rate of premature LH surge [RR = 0.03, 95% CI = 0.01 to 0.13, p < 0.001]. The PPOS protocol had a lower rate of ovarian hyperstimulation syndrome (OHSS) [RR = 0.52, 95% CI = 0.36 to 0.76, p < 0.001, I2 = 0.00%]. The secondary outcomes showed that the number of oocytes retrieved, MII oocytes, and viable embryos was higher than that of the control protocol in DOR patients [(MD = 0.33, 95% CI = 0.30 to 0.36, p < 0.001), (MD = 0.30, 95% CI = 0.27 to 0.33, p < 0.001), (MD = 0.21, 95% CI = 0.18 to 0.24, p < 0.001)] and normal ovarian reserve (NOR) patients [(MD = 1.41, 95% CI = 0.03 to 2.78, p < 0.001), (MD = 1.19, 95% CI = 0.04 to 2.35, p < 0.001), (MD = 1.01, 95% CI = 0.21 to 1.81, p = 0.01)].ConclusionThe findings suggest that PPOS is an effective ovarian stimulation protocol and is beneficial for patients with different ovarian reserve functions, which needs to be validated in more RCTs with larger samples.

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Section: Discussionsupporting

confidence: 90%

Progestin-Primed Ovarian Stimulation Protocol for Patients in Assisted Reproductive Technology: A Meta-Analysis of Randomized Controlled Trials

et al. 2021

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“…Another research on fPPOS revealed an increase in the number of M2 oocytes in the fPpos group in comparison with GnRH agonist group in young females with a high ovarian reserve [22]. Moreover, PPOS and GnRH agonists result in comparable M2 yields in a recent meta-analysis [23]. There is a possibility thus that beginning progesterone later in the cycle may cause milder suppression of the hypophysis, which leads to higher oocyte yields, and perhaps even PPOS.…”

Section: Discussionmentioning

confidence: 97%

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

Tahoun¹,

Elgazzar

Shedid

et al. 2021

Benha Journal of Applied Sciences

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Background: In vitro fertilization for women with polycystic ovarian syndrome is an essential (PCOS). New methods to improve clinical outcomes are still needed. Objective: this research investigated the effectiveness of PPOS and compared it with the standard PCOS antagonist regimen. Materials and procedures: A total of 76 PCOS women eligible for aided therapy of reproductive technology were recruited in this RCT from February 2020 to May 2021 and put in random two groups (n=38/per group). Since the sixth day of the cycle, the PPOS group has received 20 mg/day orally of Dydrogesterone, while the control group received antagonist treatment. In addition to safety, our results were chemical and clinical pregnancy. Results: oocyte retrieval counts, oocyte metaphase II (MII) and MI have been comparable. There are also comparable numbers of fertilized oocytes and cleaved embryos without any statistical difference in the number of injected oocytes. Lower antagonistic gonadotropin dosage than the PPOS group (2957.8±301.9 vs 3197.4±545.9), with higher stimulation times respectively in the PPOS group than the antagonist. Similar findings across both main outcome groups (OHSS) with no instances of FPPOS and just one case (2.6 percent) of moderate OHSS antagonists. Similar findings also for secondary results (biochemical pregnancy rate , clinical pregnancy rate and miscarriage rate). Conclusion: the established In PCOS patients receiving IVF/ICSI therapy, PPOS is a safe and successful procedure.

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“…The rate of euploid blastocysts was shown to be similar [ 25 ]. Accordingly, another meta-analysis failed to show any difference in live birth rate between PPOS and GnRH antagonist protocols [ 26 ]. Finally, Zolfaroli et al recently published a meta-analysis on 9,274 newborn babies and did not show significant differences in the risk of congenital malformations and low birth weight between women treated with PPOS protocol and those treated with GnRH analogues [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Progestin-primed ovarian stimulation for fertility preservation in women with cancer: A comparative study

et al. 2023

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Background In women scheduled for cancer treatment, oocytes cryopreservation is a well-established procedure. Random start protocols have been a substantial improvement in this setting, allowing to prevent delay in the initiation of cancer treatments. However, there is still the need to optimize the regimen of ovarian stimulation, to make treatments more patient-friendly and to reduce costs. Methods This retrospective study compares two periods (2019 and 2020), corresponding to two different ovarian stimulation regimens. In 2019, women were treated with corifollitropin, recombinant FSH and GnRH antagonists. Ovulation was triggered with GnRH agonists. In 2020, the policy changed, and women were treated with a progestin-primed ovarian stimulation (PPOS) protocol with human menopausal gonadotropin (hMG) and dual trigger (GnRH agonist and low dose hCG) Continuous data are reported as median [Interquartile Range]. To overcome expected changes in baseline characteristics of the women, the primary outcome was the ratio between the number of mature oocytes retrieved and serum anti-mullerian hormone (AMH) in ng/ml. Results Overall, 124 women were selected, 46 in 2019 and 78 in 2020. The ratio between the number of mature oocytes retrieved and serum AMH in the first and second period was 4.0 [2.3–7.1] and 4.0 [2.7–6.8], respectively (p = 0.80). The number of scans was 3 [3–4] and 3 [2–3], respectively (p<0.001). The total costs of the drugs used for ovarian stimulation were 940 € [774–1,096 €] and 520 € [434–564 €], respectively (p<0.001). Conclusions Random start PPOS with hMG and dual trigger represents an easy and affordable ovarian stimulation protocol for fertility preservation in women with cancer, showing similar efficacy and being more friendly and economical.

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Progestins versus GnRH analogues for pituitary suppression during ovarian stimulation for assisted reproductive technology: a systematic review and meta-analysis

Cited by 23 publications

References 13 publications

Progestin-Primed Ovarian Stimulation Protocol for Patients in Assisted Reproductive Technology: A Meta-Analysis of Randomized Controlled Trials

Progestin-Primed Ovarian Stimulation Protocol for Patients in Assisted Reproductive Technology: A Meta-Analysis of Randomized Controlled Trials

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

Progestin-primed ovarian stimulation for fertility preservation in women with cancer: A comparative study

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