F&S reports · 2025
Progestin-suppressed in vitro fertilization cycles yield similar outcomes to traditional protocols in patients with diminished ovarian reserve.
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Pierpoint Sara C, Gonzalez Allison M, Peavey Mary C, Williams Christopher D, Smith Laura P, Purcell Scott H, Goodman Linnea R
Аннотация
OBJECTIVE: To evaluate the effectiveness of the progestin-suppressed in vitro fertilization (IVF) stimulation protocol in patients with diminished ovarian reserve.
DESIGN: Retrospective cohort study.
SUBJECTS: Women aged 18-45 years in an academic-affiliated private fertility practice with antimüllerian hormone values <1.2 ng/m undergoing autologous IVF cycles between January 2021 and December 2024.
EXPOSURE: Administration of 10 mg/day of oral medroxyprogesterone acetate (MPA) beginning on stimulation day 1, compared with standard gonadotropin-releasing hormone antagonist and microdose leuprolide flare protocols.
MAIN OUTCOME MEASURES: Primary outcomes were ovulatory suppression and ongoing pregnancy rates. Secondary outcomes included cycle yields, logistical metrics, and medication costs.
RESULTS: A total of 669 patients (mean antimüllerian hormone 0.65 ± 0.3 ng/mL) were included. The MPA group (315 cycles) was compared with 353 non-MPA cycles (228 antagonist, 125 leuprolide flare). No premature ovulation occurred in the MPA group vs. five cases (1.4%) in the non-MPA group. Cycle length and medication dosage were similar; however, the MPA group required fewer monitoring visits (4.1 ± 0.9 vs. 5.1 ± 1.1) and had a higher number of mature oocytes retrieved (5.0 ± 3.2 vs. 4.3 ± 3.0). Blastocyst and euploid blastocyst yields were comparable between groups. Among preimplantation genetic testing for aneuploidy tested, frozen embryo transfers, rates of positive human chorionic gonadotropin (71.6% vs. 69.7%), ongoing pregnancy (60.8% vs. 64.6%), and miscarriage (5.5% vs. 4.0%) did not differ significantly. Patients in the MPA group saved an average of $453.53 ± $60.69 in medication costs and underwent 11.9 ± 3.4 fewer injections per cycle. In multivariable models, the treatment group was not associated with the likelihood of having an embryo available for transfer (odds ratio 1.26, 95% confidence interval 0.74-1.53) or clinical pregnancy (odds ratio 0.98, 95% confidence interval 0.50-1.95).
CONCLUSION: The progestin-suppressed IVF protocol provides similar reproductive outcomes in patients with diminished ovarian reserve, with the advantages of fewer monitoring visits, reduced injections, and lower medication costs.
DESIGN: Retrospective cohort study.
SUBJECTS: Women aged 18-45 years in an academic-affiliated private fertility practice with antimüllerian hormone values <1.2 ng/m undergoing autologous IVF cycles between January 2021 and December 2024.
EXPOSURE: Administration of 10 mg/day of oral medroxyprogesterone acetate (MPA) beginning on stimulation day 1, compared with standard gonadotropin-releasing hormone antagonist and microdose leuprolide flare protocols.
MAIN OUTCOME MEASURES: Primary outcomes were ovulatory suppression and ongoing pregnancy rates. Secondary outcomes included cycle yields, logistical metrics, and medication costs.
RESULTS: A total of 669 patients (mean antimüllerian hormone 0.65 ± 0.3 ng/mL) were included. The MPA group (315 cycles) was compared with 353 non-MPA cycles (228 antagonist, 125 leuprolide flare). No premature ovulation occurred in the MPA group vs. five cases (1.4%) in the non-MPA group. Cycle length and medication dosage were similar; however, the MPA group required fewer monitoring visits (4.1 ± 0.9 vs. 5.1 ± 1.1) and had a higher number of mature oocytes retrieved (5.0 ± 3.2 vs. 4.3 ± 3.0). Blastocyst and euploid blastocyst yields were comparable between groups. Among preimplantation genetic testing for aneuploidy tested, frozen embryo transfers, rates of positive human chorionic gonadotropin (71.6% vs. 69.7%), ongoing pregnancy (60.8% vs. 64.6%), and miscarriage (5.5% vs. 4.0%) did not differ significantly. Patients in the MPA group saved an average of $453.53 ± $60.69 in medication costs and underwent 11.9 ± 3.4 fewer injections per cycle. In multivariable models, the treatment group was not associated with the likelihood of having an embryo available for transfer (odds ratio 1.26, 95% confidence interval 0.74-1.53) or clinical pregnancy (odds ratio 0.98, 95% confidence interval 0.50-1.95).
CONCLUSION: The progestin-suppressed IVF protocol provides similar reproductive outcomes in patients with diminished ovarian reserve, with the advantages of fewer monitoring visits, reduced injections, and lower medication costs.