Abstract
Objective
To compare the endocrinological profiles, cycle characteristics and pregnancy outcomes of progestin-primed ovarian stimulation (PPOS) with or without clomiphene citrate (CC) supplementation in normal ovulatory women undergoing in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI).
Design
Prospective randomized controlled study.
Patient(s)
A total of 320 infertile women undergoing IVF/ICSI. Medroxyprogesterone acetate (MPA) and human menopausal gonadotropin (hMG) were simultaneously administered on menstrual cycle day 3. The women were randomized into two equal groups with or without CC supplementation.
Measures
The primary outcome measure was the percentage of women with profound pituitary suppression (luteinizing hormone (LH) < 1.0 IU/L on the trigger day). The secondary outcomes were endocrinological profiles, cycle characteristics and pregnancy outcomes.
Results
The percentage of women with profound pituitary suppression was significantly lower in the study group (hMG + MPA + CC) than in the control group (hMG + MPA) (1.9% vs. 33.1%, P < 0.001). The mean LH level during controlled ovarian stimulation (COS) was higher in the study group than in the control group (P < 0.001), but none of the patients in either group exhibited a premature LH surge. The doses of Gn in the study group were significantly lower than those in the control group (1334.06 ± 212.53 IU vs. 1488.28 ± 325.08 IU, P < 0.001). The number of oocytes retrieved was similar between the two groups (10.03 ± 5.97 vs. 10.34 ± 7.52, P > 0.05). No significant differences were observed in either the number of viable embryos or the pregnancy outcomes between the two groups.
Conclusion(s)
CC is an effective adjuvant to alleviate pituitary suppression in the PPOS protocol; however, it has no impact on clinical outcomes.
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