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The efficacy of dydrogesterone use to suppress premature luteinizing hormone surge on cycle outcomes in controlled ovarian stimulation

OBJECTIVE: Progestins are used as an alternative to gonadotropin releasing hormone (GnRH) antagonists to suppress premature luteinizing hormone (LH) surge and a flexible protocol has been defined recently. The aim of this study was to compare the efficacy of flexible protocols with dydrogesterone an...

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Autores principales: Doğan Durdağ, Gülşen, Bektaş, Gizem, Türkyılmaz, Esengül, Göktepe, Halime, Sönmezer, Meltem, Şükür, Yavuz Emre, Özmen, Batuhan, Atabekoğlu, Cem, Berker, Bülent, Aytaç, Ruşen, Sönmezer, Murat
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Galenos Publishing 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8666995/
https://www.ncbi.nlm.nih.gov/pubmed/33389927
http://dx.doi.org/10.4274/jtgga.galenos.2020.2020.0110
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author Doğan Durdağ, Gülşen
Bektaş, Gizem
Türkyılmaz, Esengül
Göktepe, Halime
Sönmezer, Meltem
Şükür, Yavuz Emre
Özmen, Batuhan
Atabekoğlu, Cem
Berker, Bülent
Aytaç, Ruşen
Sönmezer, Murat
author_facet Doğan Durdağ, Gülşen
Bektaş, Gizem
Türkyılmaz, Esengül
Göktepe, Halime
Sönmezer, Meltem
Şükür, Yavuz Emre
Özmen, Batuhan
Atabekoğlu, Cem
Berker, Bülent
Aytaç, Ruşen
Sönmezer, Murat
author_sort Doğan Durdağ, Gülşen
collection PubMed
description OBJECTIVE: Progestins are used as an alternative to gonadotropin releasing hormone (GnRH) antagonists to suppress premature luteinizing hormone (LH) surge and a flexible protocol has been defined recently. The aim of this study was to compare the efficacy of flexible protocols with dydrogesterone and GnRH antagonist in suppressing LH surge. MATERIAL AND METHODS: This retrospective, case-control study, was conducted in an infertility unit of a tertiary university hospital. A daily dose of 40 mg dydrogesterone was compared with GnRH antagonist (GnRHant) in controlled ovarian hyperstimulation cycles between July 2018 and July 2019. Dydrogesterone was started when the leading follicle was 12 mm or serum estradiol was over 300 pg/mL. A subgroup analysis of poor responder patients was also performed. RESULTS: In total there were 105 subjects aged between 23 and 41 years, 52 in the dydrogesterone group and 53 in the GnRHant group. Duration of pituitary suppression was longer in dydrogesterone group. Premature ovulation was observed in 11.5% (6/52) and 0% in the dydrogesterone and GnRHant groups, respectively. However, collected oocyte counts and metaphase II oocyte counts were found to be similar between the groups. The six patients with premature ovulation were in poor responder subgroup. CONCLUSION: Dydrogesterone can be used as an alternative to antagonist regimen in patients where embryo transfer is not planned in the same cycle. However, flexible regimen may not be appropriate in patients with diminished ovarian reserve, as advanced follicular maturation and delayed suppressive effect of oral progesterone may cause premature ovulation. Randomized controlled trials in particular patient groups are required to determine the most effective minimum dose and time of application to ensure treatment success.
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spelling pubmed-86669952021-12-16 The efficacy of dydrogesterone use to suppress premature luteinizing hormone surge on cycle outcomes in controlled ovarian stimulation Doğan Durdağ, Gülşen Bektaş, Gizem Türkyılmaz, Esengül Göktepe, Halime Sönmezer, Meltem Şükür, Yavuz Emre Özmen, Batuhan Atabekoğlu, Cem Berker, Bülent Aytaç, Ruşen Sönmezer, Murat J Turk Ger Gynecol Assoc Original Investigation OBJECTIVE: Progestins are used as an alternative to gonadotropin releasing hormone (GnRH) antagonists to suppress premature luteinizing hormone (LH) surge and a flexible protocol has been defined recently. The aim of this study was to compare the efficacy of flexible protocols with dydrogesterone and GnRH antagonist in suppressing LH surge. MATERIAL AND METHODS: This retrospective, case-control study, was conducted in an infertility unit of a tertiary university hospital. A daily dose of 40 mg dydrogesterone was compared with GnRH antagonist (GnRHant) in controlled ovarian hyperstimulation cycles between July 2018 and July 2019. Dydrogesterone was started when the leading follicle was 12 mm or serum estradiol was over 300 pg/mL. A subgroup analysis of poor responder patients was also performed. RESULTS: In total there were 105 subjects aged between 23 and 41 years, 52 in the dydrogesterone group and 53 in the GnRHant group. Duration of pituitary suppression was longer in dydrogesterone group. Premature ovulation was observed in 11.5% (6/52) and 0% in the dydrogesterone and GnRHant groups, respectively. However, collected oocyte counts and metaphase II oocyte counts were found to be similar between the groups. The six patients with premature ovulation were in poor responder subgroup. CONCLUSION: Dydrogesterone can be used as an alternative to antagonist regimen in patients where embryo transfer is not planned in the same cycle. However, flexible regimen may not be appropriate in patients with diminished ovarian reserve, as advanced follicular maturation and delayed suppressive effect of oral progesterone may cause premature ovulation. Randomized controlled trials in particular patient groups are required to determine the most effective minimum dose and time of application to ensure treatment success. Galenos Publishing 2021-12 2021-12-06 /pmc/articles/PMC8666995/ /pubmed/33389927 http://dx.doi.org/10.4274/jtgga.galenos.2020.2020.0110 Text en © Copyright 2021 by the Turkish-German Gynecological Education and Research Foundation https://creativecommons.org/licenses/by-nc-nd/4.0/Journal of the Turkish-German Gynecological Association published by Galenos Publishing House.
spellingShingle Original Investigation
Doğan Durdağ, Gülşen
Bektaş, Gizem
Türkyılmaz, Esengül
Göktepe, Halime
Sönmezer, Meltem
Şükür, Yavuz Emre
Özmen, Batuhan
Atabekoğlu, Cem
Berker, Bülent
Aytaç, Ruşen
Sönmezer, Murat
The efficacy of dydrogesterone use to suppress premature luteinizing hormone surge on cycle outcomes in controlled ovarian stimulation
title The efficacy of dydrogesterone use to suppress premature luteinizing hormone surge on cycle outcomes in controlled ovarian stimulation
title_full The efficacy of dydrogesterone use to suppress premature luteinizing hormone surge on cycle outcomes in controlled ovarian stimulation
title_fullStr The efficacy of dydrogesterone use to suppress premature luteinizing hormone surge on cycle outcomes in controlled ovarian stimulation
title_full_unstemmed The efficacy of dydrogesterone use to suppress premature luteinizing hormone surge on cycle outcomes in controlled ovarian stimulation
title_short The efficacy of dydrogesterone use to suppress premature luteinizing hormone surge on cycle outcomes in controlled ovarian stimulation
title_sort efficacy of dydrogesterone use to suppress premature luteinizing hormone surge on cycle outcomes in controlled ovarian stimulation
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8666995/
https://www.ncbi.nlm.nih.gov/pubmed/33389927
http://dx.doi.org/10.4274/jtgga.galenos.2020.2020.0110
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