Desogestrel versus antagonist injections for LH suppression in oocyte donation cycles: a crossover study

Abstract

To study whether ovarian response to corifollitropin among oocyte donors (OD) is different when oral desogestrel (DSG) is used to block the luteinizing hormone (LH) surge when compared to GnRH-antagonist use. This is a retrospective, cohort study at a private, university-based, IVF center including 35 OD. Patients underwent two stimulation cycles under corifollitropin alfa (CFT), one under an antagonist and another under DSG, between February 2015 and May 2017. In antagonist cycles, daily ganirelix was administered since a leading follicle reached 14 mm. In the DSG cycles, daily oral DSG was prescribed. The main outcome measure was oocytes retrieved. Compared to antagonist cycles, cycles under DSG received fewer injections (10.3 ± 2.8 vs. 5.0 ± 2.1, p < .001), nominally lower total supplementary gonadotropin dose (497.4 ± 338.9I U vs. 442.9 ± 332.8 IU, p=.45) with a lower total cost of medication (1018.6 ± 191.0€ vs. 813.8 ± 145.9€, p<.001). There were no differences in the total number of retrieved oocytes between groups (17.4 ± 7.5 vs. 18.6 ± 8.9, p=.34). In the corresponding oocyte recipients, clinical pregnancy rate was similar between groups: 52.0% vs. 58.6%, respectively (p=.78). ODs’ stimulation’s response under DSG is similar when compared to (17.4 ± 7.5 vs. 18.6 ± 8.9, p=.34) but associated with less injections and lower medication costs. The main advantage of this strategy is its simplicity, an aspect of utmost importance in the management of ODs.

摘要

本研究旨在探讨应用口服去氧孕烯（DSG）和应用促性腺激素释放激素抑制剂（GnRH-a）进行阻断黄体生成素（LH）过度升高时, 在应用绒促卵泡素的卵母细胞捐赠者（OD）中的卵巢反应是否不同。本研究是一项回顾性队列研究, 在一所私立的大学附属的IVF中心进行, 包括35 名OD。于2015年2月至2017年5月期间, 患者应用绒促卵泡素（CFT）进行两个促排卵周期, 一次同时应用GnRH-a, 另一次同时给与DSG。在拮抗周期中, 当优势卵泡达到14mm时每天应用加尼瑞克。在DSG周期中, 每日口服DSG。主要观察指标是取出的卵母细胞数量。与拮抗剂周期比较, 应用DSG的周期接受的注射操作较少(10.3±2.8vs.5.0±2.1, p<.001), 名义上补充促性腺激素总剂量较低(497.4 ± 338.9I U vs. 442.9 ± 332.8 IU, p=.45), 药物总成本较低(1018.6 ± 191.0€ vs. 813.8 ± 145.9€, p<.001)。两组间取出的卵母细胞总数无差异(17.4 ± 7.5 vs. 18.6 ± 8.9, p=.34)。在相应的卵母细胞接受者中, 两组之间的临床妊娠率相似：分别为52.0%和58.6%(p=.78)。 在应用DSG时OD对刺激的反应与应用拮抗剂时相同 (17.4 ± 7.5 vs. 18.6 ± 8.9, p=.34) , 但是接受注射操作较少, 并且药物成本较低。本策略的优点是应用简便, 这是在OD的管理中最重要的一个方面。

The Chinese abstracts are translated by Prof. Dr. Xiangyan Ruan and her team: Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China.

Keywords:

• Desogestrel
• LH suppression
• progesterone primed ovarian stimulation
• oocyte donors
• corifollitropin
• antagonist

Disclosure statement

No potential conflict of interest was reported by the authors. Funding for this work was not received. This research was performed under the auspices of ‘Catedra d’Investigacio en Obstetrıcia I Ginecologia’ of the Department of Obstetrics, Gynecology and Reproductive Medicine, Hospital Universitario Dexeus, Universitat Autonoma de Barcelona.