Preventing the premature luteinizing hormone surge produced by gestagen in the modified ovarian stimulation protocol in assisted reproductive technology programs
Standard ovarian stimulation regimens use gonadotropin in combination with gonadotropin-releasing hormone (GnRH) analogues to prevent the premature luteinizing hormone (LH) surge that improves the outcomes of assisted reproductive technology (ART) programs, by optimizing the number of extracted oocytes and the synchronization of the endometrium to embryo transfer. However, GnRH analogues have many disadvantages: uneasiness to use (the drug must be accurately prepared and be subcutaneously injected), cost, and different side effects. This has aroused interest in searching for medical alternatives. Current cryopreservation technologies, cycle segmentation strategy for delayed embryo transfer allow one to consider new approaches to ovarian stimulation without the limitations associated with endometrial effects and risks associated with ovarian hyperstimulation syndrome. At present, an ovarian stimulation strategy has been proposed, when gestagen is prescribed instead of a GnRH analogue, while oocyte (embryo) vitrification eliminates possible adverse effects on endometrial susceptibility. The advantage of this approach is ease of use, oral administration, affordability, and no adverse reactions.Korneeva I.E., Kovalchuk A.I.
Conclusion. The use of gestagens to suppress endogenous LH release may become the first choice for ovarian stimulation with planned oocyte or embryo cryopreservation, preimplantation genetic testing, in donor cycles, as well as in ovarian stimulation protocols for the luteal phase of the menstrual cycle or in double superovulation stimulation, which always require subsequent cryopreservation of biological material.
Keywords
ART
ovarian hyperstimulation syndrome
premature ovulation
progestins
cycle segmentation
References
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Received 13.08.2020
Accepted 07.09.2020
About the Authors
Irina Ye. Korneeva, PhD/Med, professor, Head of the Scientific and Educational Center of Auxiliary Reproductive Technologies with a Clinical Department named after Frederick Paulsen, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Healthcare of the Russian Federation.4, Oparina str., Moscow, 117997, Russian Federation.
Alla I. Kovalchuk, PhD candidate, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Healthcare of the Russian Federation. Tel.: +7(999)999-40-47. E-mail: kovalchukalla27@mail.ru. 4, Oparina str., Moscow, 117997, Russian Federation.
For citation: Korneeva I.E., Kovalchuk A.I. Preventing the premature luteinizing hormone surge produced by gestagen in the modified ovarian stimulation protocol
in assisted reproductive technology programs.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2020; 11: 39-43 (in Russian).
https://dx.doi.org/10.18565/aig.2020.11.39-43
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