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

作者：Dong, J.; Wang, Y.; Chai, W. R.; Hong, Q. Q.; Wang, N. L.; Sun, L. H.; Long, H.; Wang, L.; Tian, H.; Lyu, Q. F.; Lu, X. F.; Chen, Q. J.^*; Kuang, Y. P.^*

来源：BJOG: An International Journal of Obstetrics and Gynaecology , 2017, 124(7): 1048-1055.

DOI：10.1111/1471-0528.14622

• Controlled ovarian stimulation
• luteinising hormone surge
• progestin

Objective To investigate the clinical outcome and endocrinological characteristics of progestin-primed ovarian stimulation (PPOS) using 4 versus 10 mg of medroxyprogesterone acetate (MPA) per day in infertile women with normal ovary reserve. @@@ Design A randomised parallel controlled trial. @@@ Setting Tertiary-care academic medical centre. @@@ Participants A cohort of 300 infertile women undergoing in vitro fertilisation (IVF)/intracytoplasmic sperm injection (ICSI) treatment. @@@ Methods Human menopausal gonadotropin (hMG; 225 iu per day) and MPA (group A, 10 mg per day; group B, 4 mg per day) were started simultaneously from cycle day 3 onwards. Ovulation was co-triggered by human chorionic gonadotropin (hCG; 1000 iu) and gonadotropin-releasing hormone agonist (GnRH agonist; 0.1 mg) when dominant follicles matured. Viable embryos were cryopreserved for later frozen embryo transfer (FET) in both groups. @@@ Main outcome measures The primary outcome measure was the number of oocytes retrieved. Secondary outcomes included the incidence of a premature surge in luteinising hormone (LH), the number of viable embryos, and clinical pregnancy outcomes. @@@ Results The number of oocytes retrieved and viable embryos were similar between two groups (9.8 +/- 6.3 versus 9.6 +/- 5.9; 4.2 +/- 2.6 versus 3.7 +/- 3.0; P > 0.05). No significant difference was found in clinical pregnancy rate (58.0 versus 48.7%) and live birth rate per participant (48.7 versus 42.0%; P > 0.05). No premature LH surge and ovarian hyperstimulation syndrome (OHSS) occurred in either group. @@@ Conclusions Progestin-primed ovarian stimulation (PPOS) using 4 or 10 mg of MPA per day was comparable in terms of the number of oocytes retrieved and pregnancy outcome after FET. The administration of 4 mg of MPA per day was sufficient to prevent an untimely LH rise in women undergoing IVF/ICSI treatment.

• 出版日期2017-6
• 单位上海交通大学