Skip to main content
SpringerLink
Log in

Flexible GnRH Antagonist Protocol versus Progestin-primed Ovarian Stimulation (PPOS) Protocol in Patients with Polycystic Ovary Syndrome: Comparison of Clinical Outcomes and Ovarian Response

  • Published:
Current Medical Science Aims and scope Submit manuscript

Summary

Polycystic ovary syndrome (PCOS) is one of the most common causes of infertility in women. Progestin-primed ovarian stimulation (PPOS) protocol, which used oral progestin to prevent premature luteinizing hormone (LH) surges in ovarian stimulation, has been proved to be effective and safe in patients with PCOS. The aim of the present study was to compare the efficacy of PPOS protocol with that of the traditional gonadotropin-releasing hormone (GnRH) antagonist protocol in patients with PCOS. A total of 157 patients undergoing in-vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) were recruited into this study. The patients were divided into two groups by the stimulation protocols: the GnRH antagonist protocol group and the PPOS protocol group. There was no significant difference in the clinical characteristics between the two groups. Dose and duration of gonadotropin were higher in the PPOS protocol group. Estradiol levels on the day of human chorionic gonadotropin (hCG) administration were significantly lower in the PPOS protocol group. Fertilization rates and the number of good quality embryos were similar between the two groups. Remarkably, we found 6 patients with moderate ovarian hyperstimulation syndrome (OHSS) in the GnRH antagonist protocol group but 0 in the PPOS protocol group. A total of 127 women completed their frozen embryo transfer (FET) cycles. There were no significant differences between the two groups in terms of clinical pregnancy rate per transfer, implantation rate, first-trimester miscarriage rate and on-going pregnancy rate per transfer. To conclude, PPOS protocol decreased the incidence of OHSS without adversely affecting clinical outcomes in patients with PCOS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Thessaloniki, Eshre Asrm-Sponsored Pcos Consensus Workshop Group. Consensus on infertility treatment related to polycystic ovary syndrome. Hum Reprod, 2008,23:462–477

    Article  Google Scholar 

  2. Boyle JA, Cunningham J, O’Dea K, et al. Prevalence of polycystic ovary syndrome in a sample of Indigenous women in Darwin, Australia. Med J Aust, 2012,196(1):62–66

    Article  PubMed  Google Scholar 

  3. Ma Y, Li R, Qiao J, et al. Characteristics of abnormal menstrual cycle and polycystic ovary syndrome in community and hospital populations. Chin Med J, 2010,123(16):2185–2189

    PubMed  Google Scholar 

  4. Rotterdam ESHRE/ASRM-Sponsored PCOS consensus workshop group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod, 2004,19(1):41–47

    Article  Google Scholar 

  5. Balen AH, Morley LC, Misso M, et al. The management of anovulatory infertility in women with polycystic ovary syndrome: an analysis of the evidence to support the development of global WHO guidance. Hum Reprod Update, 2016,22(6):687–708

    Article  PubMed  Google Scholar 

  6. Kuang Y, Chen Q, Fu Y, et al. Medroxyprogesterone acetate is an effective oral alternative for preventing premature luteinizing hormone surges in women undergoing controlled ovarian hyperstimulation for in vitro fertilization. Fertil Steril, 2015,104(1):62–70.e3

    Article  CAS  PubMed  Google Scholar 

  7. Crha I, Ventruba P, Filipinská E, et al. Medroxy-progesteron acetate use to block LH surge in oocyte donor stimulation. Ceska Gynekol, 2018,83(1):11–16

    CAS  PubMed  Google Scholar 

  8. Kuang Y, Hong Q, Chen Q, et al. Luteal-phase ovarian stimulation is feasible for producing competent oocytes in women undergoing in vitro fertilization/intracytoplasmic sperm injection treatment, with optimal pregnancy outcomes in frozen-thawed embryo transfer cycles. Fertil Steril, 2014,101(1):105–111

    Article  CAS  Google Scholar 

  9. Wang Y, Chen Q, Wang N, et al. Controlled Ovarian Stimulation Using Medroxyprogesterone Acetate and hMG in Patients With Polycystic Ovary Syndrome Treated for IVF: A Double-Blind Randomized Crossover Clinical Trial. Medicine (Baltimore), 2016,95(9):e2939

    Article  CAS  Google Scholar 

  10. Alpha Scientists in Reproductive Medicine and ESHRE Special Interest Group of Embryology. The Istanbul consensus workshop on embryo assessment: proceedings of an expert meeting. Hum Reprod, 2011,26(6):1270–1283

    Article  Google Scholar 

  11. Schmidt DW, Maier DB, Nulsen JC, et al. Reducing the dose of human chorionic gonadotropin in high responders does not affect the outcomes of in vitro fertilization. Fertil Steril, 2004,82(4):841–846

    Article  CAS  PubMed  Google Scholar 

  12. Xiao Z, Zhou X, Xu W, et al. Natural cycle is superior to hormone replacement therapy cycle for vitrificated-preserved frozen-thawed embryo transfer. Syst Biol Reprod Med, 2012,58(2):107–112

    Article  PubMed  Google Scholar 

  13. Mourad S, Brown J, Farquhar C. Interventions for the prevention of OHSS in ART cycles: an overview of Cochrane reviews. Cochrane Database Syst Rev, 2017,23,1:CD012103

    Google Scholar 

  14. Toftager M, Sylvest R, Schmidt L, et al. Quality of life and psychosocial and physical well-being among 1,023 women during their first assisted reproductive technology treatment: secondary outcome to a randomized controlled trial comparing gonadotropin-releasing hormone (GnRH) antagonist and GnRH agonist protocols. Fertil Steril, 2018,109(1):154–164

    Article  CAS  PubMed  Google Scholar 

  15. Yu S, Long H, Chang HY, et al. New application of dydrogesterone as a part of a progestin-primed ovarian stimulation protocol for IVF: a randomized controlled trial including 516 first IVF/ICSI cycles. Hum Reprod, 2018,33(2):229–237

    Article  CAS  PubMed  Google Scholar 

  16. Wang N, Lin J, Zhu Q, et al. Comparison of neonatal outcomes and live-birth defects after progestin-primed ovarian stimulation versus conventional ovarian stimulation for in vitro fertilization: A large retrospective cohort study. Medicine (Baltimore), 2018,97(34):e11906

    Article  CAS  Google Scholar 

  17. Zhu X, Ye H, Fu Y. Use of Utrogestan during controlled ovarian hyperstimulation in normally ovulating women undergoing in vitro fertilization or intracytoplasmic sperm injection treatments in combination with a “freeze all” strategy: a randomized controlled dose-finding study of 100 mg versus 200 mg. Fertil Steril, 2017,107(2):379–386.e4

    Article  CAS  PubMed  Google Scholar 

  18. Chen Q, Wang Y, Sun L, et al. Controlled ovulation of the dominant follicle using progestin in minimal stimulation in poor responders. Reprod Biol Endocrinol, 2017,15(1):71

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Yucel O, Ekin M, Cengiz H, et al. Comparison of estradiol and progesterone priming/antagonist/letrozole and microdose flare-up protocols for poor responders undergoing intracytoplasmic sperm injection. Gynecol Endocrinol, 2014,30(9):653–656

    Article  CAS  PubMed  Google Scholar 

  20. Roque M, Valle M, Guimarães F, et al. Freeze-all policy: fresh vs. frozen-thawed embryo transfer. Fertil Steril, 2015,103(5):1190–1193

    Article  PubMed  Google Scholar 

  21. Meng Y, Guo Y, Qian Y, et al. Effects of GnRH antagonist on endometrial protein profiles in the window of implantation. Proteomics, 2014,14(20):2350–2359

    Article  CAS  PubMed  Google Scholar 

  22. Griesinger G, Venetis CA, Marx T, et al. Oral contraceptive pill pretreatment in ovarian stimulation with GnRH antagonists for IVF: a systematic review and meta-analysis. Fertil Steril, 2008,90(4):1055–1063

    Article  CAS  PubMed  Google Scholar 

  23. Fatemi HM, Doody K, Griesinger G, et al. High ovarian response does not jeopardize ongoing pregnancy rates and increases cumulative pregnancy rates in a GnRH-antagonist protocol. Hum Reprod, 2013,28(2):442–452

    Article  CAS  PubMed  Google Scholar 

  24. Bosch E, Labarta E, Pellicer A. Does cumulative live birth plateau beyond a certain ovarian response? Fertil Steril, 2017,108(6):943

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Center for Reproductive Medicine, Renmin Hospital of Wuhan University, Wuhan, 430060, China

    Zhuo-ni Xiao, Jia-li Peng, Jing Yang & Wang-ming Xu

Authors
  1. Zhuo-ni Xiao
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jia-li Peng
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jing Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Wang-ming Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Zhuo-ni Xiao.

Additional information

This work was supported by the National Natural Science Foundation of China (Nos. 81471455, 81100418).

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Xiao, Zn., Peng, Jl., Yang, J. et al. Flexible GnRH Antagonist Protocol versus Progestin-primed Ovarian Stimulation (PPOS) Protocol in Patients with Polycystic Ovary Syndrome: Comparison of Clinical Outcomes and Ovarian Response. CURR MED SCI 39, 431–436 (2019). https://doi.org/10.1007/s11596-019-2055-x

Download citation

  • Received:

  • Revised:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11596-019-2055-x

Key words

Search

Navigation