DYDROGESTERONE VERSUS CONVENTIONAL GONADOTROPIN RELEASING HORMONE ANTAGONIST FOR PREVENTION OF PREMATURE LUTEINIZING HORMONE SURGE DURING CONTROLLED OVARIAN STIMULATION

Problem statement

Traditionally, during in-vitro fertilization for controlled ovarian stimulation (COS) with short protocol for prevention of premature luteinizing hormone (LH) surge clinicians use gonadotropin-releasing hormone antagonists (GnRH-antagonist). Recent data indicates that premature LH surge may be prevented also by progestins. Nowadays, there are limited studies about the outcomes of COS using of progestins. Therefore, this study aimed to compare the efficacy of progestins and GnRH-antagonists for blocking premature LH surge and premature ovulation in oocyte donors (ODs).

Methods

In prospective, randomized study were participated one-hundred and four ODs. Recombinant gonadotropin was administered for COS in all participants. According to the ovarian response, Human Menopausal Gonadotropin was added. Intervention group (group I, n=55) received 20 mg of Dydrogesterone from the first day of stimulation till trigger day and the control group (group II, n=49) received GnRH-antagonist when the leading follicle reached 14 mm in diameter till trigger day. The primary outcome measure was the incidence of a premature LH surge, and the secondary outcome - the total number and metaphase II (MII) oocytes obtained by follicular transvaginal aspiration.

Results

There were no statistically significant differences in patients’ age, BMI and AMH levels between two groups. None of the participants experienced a premature LH surge and ovulation. There was no statistically significant difference in the number of received and MII oocytes between groups (23,7 vs 25.9 p=0.3), (18.3 vs 19.9 p=0.36) respectively. The duration of stimulation was similar also in both groups (9.6 vs 9.9 days, p=0.41). Similarly, there was no statistically significant difference in the total dose of gonadotropins (2269.2 IU vs 2423.4 IU, p=0.08).

Conclusion

The results of the present study demonstrate the equal effectiveness of Dydrogesterone and GnRH-antagonist for prevention of premature LH surge without any adverse effect on oocyte quantity and quality. Dydrogesterone is a financially profitable and easy to use alternative to GnRH-antagonist, which can be used as in ODs as well as in patients where embryo transfer is not planned in the current cycle.