Evaluation of pregnancy outcomes using medroxyprogesterone acetate versus gonadotropin-releasing hormone antagonist in ovarian stimulation: A retrospective cohort study

Limited studies have compared pregnancy outcomes with medroxyprogesterone acetate (MPA) vs. gonadotropin-releasing hormone antagonist (GnRH antagonist) in ovarian stimulation protocols. The results show heterogeneity.

This study aims to assess pregnancy outcomes with the use of MPA instead of GnRH antagonist for ovarian stimulation in donor-recipient cycles.

This retrospective study was carried out from June 2016 to May 2019. The study included 250 donors receiving ovarian stimulation with 2 different protocols: group 1 (n = 109) receiving GnRH antagonist (0.25 mg/day) from the 5th or 6th  day of menses and group 2 (n = 141) receiving MPA (10 mg/day) from the second day of menses. In 384 recipients, 2 good-quality blastocysts were transferred after endometrial preparation. The primary endpoint was live birth in recipients.

The results showed that live birth was comparable in both recipient groups (59% vs. 60%, OR: 0.63, 95% CI: 0.13-2.99, p = 0.559). The number of live-born fetuses (adjusted OR: 0.57, 95% CI: 0.31-1.05, p > 0.01) showed no significant difference in both groups. However, the implantation rate with twin sacs was significantly lower in group 2 (adjusted OR: 0.57, 95% CI: 0.33-0.99, p = 0.05). The regression analysis for goodquality blastocyst proportion was comparable (OR: 0.63, 95% CI: -4.33-5.60, p = 0.802) in both donor groups. The mean stimulation cost in group 2 was less than in group 1.

MPA had a comparable live birth and embryological outcomes in both groups. Oral administration makes it convenient, acceptable, and patient-friendly. Its cost-effectiveness and convenience open new possibilities in ovarian stimulation protocols.