Related Experiment Video
Updated: Sep 18, 2025
OP-IVM: Combining In vitro Maturation after Oocyte Retrieval with Gynecological Surgery
Published on: May 9, 2021
Cumulative Live Birth Rates in Women Undergoing Progestin-Primed Ovarian Stimulation Using Medroxyprogesterone
Fenglu Wu1, Jing Lin2, Jing Zhang1
1Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.
Purpose:
To investigate possible differences in cumulative live birth rates (CLBRs) among three progestins medroxyprogesterone acetate (MPA), dydrogesterone (DYG), and Progesterone within the progestin-primed ovarian stimulation (PPOS) protocol.
Patients And Methods:
This retrospective study included 21,159 women undergoing one of three ovarian stimulation protocols, hMG + MPA, hMG + DYG, or hMG + Progesterone, between September 2013 and January 2024 in our centre. Patients received oral progestins once daily as per their assigned protocol with human menopausal gonadotropin initiated on menstrual cycle day 3. The primary outcome was the CLBR. Secondary outcomes comprised ovarian stimulation parameters, pregnancy outcomes per embryo transfer, and cumulative outcomes per individual.
Results:
The CLBR demonstrated no statistically significant differences across the three progestin regimens: MPA (6409/14,930, 42.9%), DYG (1430/3205, 44.6%), and Progesterone (1297/3024, 42.9%; p = 0.203). Kaplan-Meier analysis revealed progressive CLBR accumulation through 5 frozen-thawed embryo transfer (FET) cycles, reaching 87.6%, 95.6%, and 93.7% for MPA, DYG, and Progesterone groups, respectively, with all groups achieving 50% CLBR by the second cycle. Cox regression adjusted for confounders confirmed comparable CLBR trajectories (p > 0.05), while multivariable logistic regression showed no association between progestin type and per-cycle live birth rate (p > 0.05). Notably, the Progesterone group exhibited elevated serum progesterone levels (trigger day: p < 0.05), whereas both DYG and Progesterone groups demonstrated higher LH levels than MPA (p < 0.05).
Conclusion:
Our findings establish clinical equivalence in cumulative live birth outcomes among MPA, DYG, and Progesterone when implemented within the PPOS framework. This evidence supports protocol flexibility in progestin selection, enabling personalized decisions based on pharmacological characteristics, cost considerations, and patient tolerance.
More Related Videos
Related Concept Videos
01:27Ovarian Cycle
01:30Hormonal Control of the Ovarian Cycle
Before puberty, the hypothalamus releases GnRH in a low frequency, low amplitude pulsatile manner. This along with the immature hypothalamic-pituitary-gonadal axis activity, results in low estrogen levels and the absence of a fully functional ovarian cycle. At puberty, GnRH secretion increases in both frequency and...
01:22Hormonal Regulation of the Menstrual Cycle
At puberty, GnRH begins a pulsatile release pattern, which triggers the anterior pituitary gland to secrete follicle-stimulating hormone (FSH) and luteinizing hormone (LH). The frequency and amplitude of GnRH pulses vary across the menstrual cycle, with faster pulses favoring LH release and slower pulses favoring FSH...
02:07Oogenesis