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The prevalence of infertility is 16.7% worldwide, and characteristics and causes of infertility are different between industrialized, developed and developing countries (1,2). Diagnosis of infertility results in choosing appropriate therapeutic approach in terms of time, and cost is the necessity of treatment planning (1,2). In vitro fertilization (IVF) is a fully coordinated sequence of procedures that begins with severe and controlled stimulation of ovaries using exogenous gonadotropin and is followed by resumption of oocytes from ovaries under the guide of transvaginal sonography; thereafter the process is continued by IVF and transfer of the embryo in a trans-cervical manner into the uterus (3,4). Surge or sudden early peak of luteinizing hormone (LH) is one of the causes of cycle cancelation during controlled ovarian stimulation in patients undergoing IVF. LH secretion stimulates ovulation during the normal cycle in response to a rapid increase of estradiol concentration. However, an early surge of LH can put the oocyte resumption at risk during IVF cycle (5). Based on the previous findings, incidence of the early LH surge among patients is totally different and varies between 0.34% and 38%, although there is growing evidence that elder patients with reduced ovarian reserve are at great risk of early LH surge (6). Increased concentration of LH in early stages of follicle development could have adverse influences, especially on the pregnancy rate. Many efforts have been done to reduce the incidence of early LH surge including various stimulatory protocols by GnRH agonists and antagonists. In this term, it has been documented that desensitization by GnRH antagonists could increase follicular synchronization (5,7,8). Antagonist protocol also could cause rapid and reversible LH suppression without early flare effect (6-9). On the other hand, it has been suggested that adjuvant therapy with GnRH agonists could overcome early luteinization and need for repeated measurements of serum LH. Although, adjuvant therapy with GnRH agonist could sometimes reduce response to Abstract Objectives: The aim of the study was to investigate the role of medroxyprogesterone acetate (MPA) in the prevention of luteinizing hormone (LH) surge during controlled ovarian hyperstimulation (COH). Characteristics of cycle and pregnancy outcomes were compared in subsequent frozen-thawed embryo transfer (FET) cycles. Materials and Methods: In a prospective controlled study, In vitro fertilization (IVF)/intracytoplasmic sperm injection treatment was done in 99 patients. In the case group, hMG and MPA were administered from third day of the cycle, simultaneously. As dominant follicles matured, ovulation was induced by hCG or GnRH agonist. hMG and GnRH were administrated to the control group. For later transfer in both protocols, viable embryos were cryopreserved. The primary outcome measured was the incidence of premature LH surge and a number of oocytes retrieved. Clinical pregnancy outcomes from FETs were secondary outcomes. Results: The number of oocytes retrieved in both case and control groups were equal. LH suppression persisted during ovarian stimulation in the case group, and there was no incidence of premature LH surge. There was no significant difference between amounts of follicles, mature follicles, oocytes resumed and obtained embryos between 2 groups (P > 0.05). Conclusions: The results showed that in a woman undergoing COH, MPA as an oral drug was effective in the prevention of premature LH surge. The results would help to establish a new method for ovarian stimulation in combination with embryo cryopreservation.

international journal of women's health and reproduction sciences

Comparison of Medroxyprogesterone Acetate With Cetrotide for Prevention of Premature Luteinizing Hormone Surges in Women Undergoing In Vitro Fertilization