Use of medroxyprogesterone acetate in women with ovarian endometriosis undergoing controlled ovarian hyperstimulation for in vitro fertilization

Abstract

This study investigated the use of medroxyprogesterone acetate (MPA) or a short protocol for controlled ovarian hyperstimulation (COH) in patients with advanced endometriosis who have normal ovarian function, and to compare cycle characteristics and pregnancy outcomes after frozen-thawed embryo transfer (FET). This was a retrospective case-control study of 244 patients with advanced endometriosis undering COH. The patients were allocated to three groups: the surgery group with MPA COH (62 patients, 71 IVF/ICSI cycles, 78 FET cycles); the aspiration group with MPA COH (85 patients had ovarian "chocolate" cysts (>3 cm) aspirated, 90 IVF/ICSI cycles, 76 FET cycles); and the short protocol group (97 patients, 101 IVF/ICSI cycles, 51 FET cycles). The results showed that higher rates of mature oocyte, D3 high quality embryo, hMG dose were observed in the two study groups using MPA compared with the short protocol. The number of >10-14 mm follicles on the trigger day, D3 top-quality embryos, viable embryos, rates of cancellation, fertilization, implantation, pregnancy outcomes were similar among the three groups. The oocytes, embryos, and pregnancy outcomes were not influenced by endometrioma surgery or presence of endometrioma. MPA COH could be effective for women with ovarian advanced endometriosis who had normal ovarian function.

Figure 1

Patient flowchart.

Figure 2

Hormone profiles of the medroxyprogesterone acetate (MPA) + human menopausal gonadotrophin (hMG) protocol in the three groups with trigger by gonadotropin-releasing hormone agonist (GnRH-a) or human chorionic gonadotrophin (hCG). There were temporal associations among circulating levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), estrogen (E₂), and progesterone (P). The green line shows the surgery group, the red line refers to the aspiration group, and the blue line refers to the short protocol group. The results are presented as mean ± SD. *P < 0.05 at the same time point.