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Ovarian Cycle

Ovarian Cycle

The menstrual cycle includes a critical component known as the ovarian cycle, which undergoes two main phases each month—the follicular phase and the luteal phase. The follicular phase is variable and averaging around 14 days. Ovulation, triggered by a surge in luteinizing hormone (LH), marks the transition between the two phases. The second phase, the luteal phase, is relatively consistent, lasting approximately 14 days, and is marked by the activity of the corpus luteum. While a cycle...

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Surgical Techniques to Optimize Ovarian Reserve during Laparoscopic Cystectomy for Ovarian Endometrioma

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Progestin-Primed Ovarian Stimulation Protocol for Patients With Endometrioma.

Ai-Min Yang¹, Teng-Fei Feng¹, Yan Han¹

¹Hebei Key Laboratory of Infertility and Genetics, Hebei Clinical Research Center for Birth Defects, Department of Reproductive Medicine, Second Hospital of Hebei Medical University, Shijiazhuang, China.

Frontiers in Endocrinology

|May 16, 2022

Summary

The progestin-primed ovarian stimulation (PPOS) protocol may lead to poorer pregnancy outcomes, including live birth, compared to the ultra-long gonadotrophin-releasing hormone agonist (GnRHa) protocol in women with endometrioma undergoing IVF. However, PPOS showed similar results to the GnRH antagonist (GnRHant) protocol.

Keywords:

endometrioma in vitro fertilization-embryo transfer (IVF-EF)live birth progestin-primed ovarian stimulation (PPOS)ultra-long GnRH agonist protocol

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Area of Science:

Reproductive Endocrinology
In Vitro Fertilization
Gynecologic Oncology

Background:

Endometrioma affects fertility and IVF outcomes.
Controlled ovarian stimulation (COS) protocols vary in efficacy for patients with endometrioma.
Progestin-primed ovarian stimulation (PPOS) is a widely used COS protocol.

Purpose of the Study:

To compare pregnancy outcomes of the PPOS protocol versus other COS protocols (ultra-long GnRHa and GnRHant) in patients with endometrioma undergoing IVF/ICSI-ET.
To evaluate the impact of different COS protocols on live birth rates, implantation, and pregnancy rates.

Main Methods:

Retrospective cohort study of 605 infertile patients with endometrioma undergoing IVF/ICSI-ET.
Comparison of PPOS protocol with ultra-long GnRHa and GnRHant protocols.
Multivariable logistic regression analysis to assess the effect of COS protocols on reproductive outcomes, with live birth as the primary outcome.

Main Results:

The PPOS protocol was associated with significantly lower biochemical and clinical pregnancy rates compared to the ultra-long GnRHa protocol.
The ultra-long GnRHa protocol showed a significantly higher probability of live birth compared to the PPOS protocol.
No significant differences were observed in implantation rates, clinical pregnancy, ongoing pregnancy, or live birth rates between the PPOS and GnRHant protocols.

Conclusions:

The PPOS protocol may be associated with inferior reproductive outcomes, particularly in terms of biochemical pregnancy, clinical pregnancy, and live birth, when compared to the ultra-long GnRHa protocol in patients with endometrioma.
The PPOS protocol demonstrated comparable outcomes to the GnRHant protocol regarding implantation, clinical pregnancy, ongoing pregnancy, and live birth.
These findings suggest that the choice of COS protocol may influence IVF success rates in patients with endometrioma.