RESUMEN
In vitro fertilization (IVF) cycles are associated with a defective luteal phase. Although progesterone supplementation to treat this problem is standard practice, estrogen addition is debatable. Our aim was to compare pregnancy outcomes in 220 patients undergoing antagonist intracytoplasmic sperm injection (ICSI) cycles protocol. The patients were randomly assigned into two equal groups to receive either vaginal progesterone alone (90 mg once daily) starting on the day of oocyte retrieval for up to 12 weeks if pregnancy occurred or estradiol addition (2 mg twice daily) starting on the same day and continuing up to seven weeks (foetal viability scan). Primary outcomes were pregnancy and ongoing pregnancy rates per embryo transfer. Secondary outcomes were implantation and early pregnancy loss rates. Pregnancy rates showed no significant difference between group 1 (39.09%) and 2 (43.63%) (p value = 0.3). Similarly, both groups were comparable regarding ongoing pregnancy rate (32.7% group 1 and 36.3% group 2, p value = 0.1). Implantation rates showed no difference between group 1 (19.25%) and group 2 (23.44%) (p value = 0.2). Early pregnancy loss rates were comparable, with 6.3% and 7.2% in groups 1 and 2, respectively, (p value = 0.4). In conclusion, the addition of 4 mg estrogen daily to progesterone for luteal support in antagonist ICSI cycles is not beneficial for pregnancy outcome.
Asunto(s)
Estradiol/uso terapéutico , Fármacos para la Fertilidad Femenina/uso terapéutico , Hormona Liberadora de Gonadotropina/análogos & derivados , Antagonistas de Hormonas/uso terapéutico , Infertilidad Femenina/tratamiento farmacológico , Inducción de la Ovulación/métodos , Progesterona/uso terapéutico , Inyecciones de Esperma Intracitoplasmáticas , Adulto , Estradiol/farmacología , Femenino , Fármacos para la Fertilidad Femenina/farmacología , Hormona Folículo Estimulante Humana/farmacología , Hormona Folículo Estimulante Humana/uso terapéutico , Hormona Liberadora de Gonadotropina/antagonistas & inhibidores , Hormona Liberadora de Gonadotropina/farmacología , Hormona Liberadora de Gonadotropina/uso terapéutico , Antagonistas de Hormonas/farmacología , Humanos , Folículo Ovárico/efectos de los fármacos , Progesterona/farmacología , Proteínas Recombinantes/farmacología , Proteínas Recombinantes/uso terapéutico , Resultado del TratamientoRESUMEN
AIM: To compare the efficacy and safety of the clomiphene citrate (CC) stair-step protocol with standard gonadotrophin (follicle-stimulating hormone) treatment in clomiphene-resistant polycystic ovary syndrome (PCOS) patients. The study was a prospective cohort study in a tertiary infertility center in Abu Dhabi, United Arab Emirates (UAE). METHODS: The subjects consisted of 100 PCOS CC-resistant patients who attended between January 2014 and January 2015. Fifty received CC again but in accordance with the stair-step protocol, and the other 50 received the standard gonadotrophin treatment used in the center in which the study was conducted. The primary outcome measure was dominant follicle achievement; the secondary outcome measures were (i) clinical pregnancy rate; (ii) time to ovulation measured from treatment initiation to sonographic confirmation of a dominant follicle in days; and (iii) adverse effect occurrence. RESULTS: There was no difference between the two treatment modalities concerning the ability to achieve a dominant follicle or the clinical pregnancy rate. The time to ovulation was significantly shorter with the CC stair-step protocol than with gonadotrophin treatment. Ovarian hyperstimulation syndrome and ovarian cyst formation were more likely to occur with gonadotrophin treatment. CONCLUSION: Clomiphene citrate stair-step protocol can be offered to PCOS CC-resistant patients as an alternative to gonadotrophin therapy with similar efficacy.