Progestin ovulation suppression for in vitro fertilization – an inclusive prospective cohort trial

To assess the efficacy of progestin for ovulatory suppression during in vitro fertilization (IVF) stimulation. Patients 18-43 years undergoing an autologous provera-protocol IVF cycle between 4/22 - 4/23 were compared to cycles from 1/21 - 3/22, during which the provera protocol was not in use. Data was prospectively collected on the provera group. The primary outcomes were successful ovulatory suppression and number of oocytes retrieved. A secondary analysis evaluated the subgroup who underwent a freeze-all cycle with intent for future frozen embryo transfer (FET) (excluding oocyte cryopreservation cycles) to evaluate outcomes including fertilization, blastocyst, and euploidy rate in the subset undergoing PGT-a. Clinical pregnancy rates of patients who underwent FET from a provera-derived cycle were compared to the control cycles FET data. Both primary and subsequent FET data was included. Student’s t-test and Chi-squared test were used as appropriate. There were a total of 198 patients in the provera group (age 35.3 +/- 4.4 years) compared to 559 control cases (age 35.7 +/- 4.7; p = 0.49). AMH values were similar between groups. In the provera group, there were no cases of premature ovulation (0%) compared to a total of five cases in the control group (5/559 cycles; 0.9%). Cycle outcomes are shown in table 1. Of the patients with pregnancy data available, clinical pregnancy rates were similar (provera FET 48/66, 72.7% vs. control FET 294/459, 64.1%; p = 0.17). Patients in the provera group saved an average of $658 on medications and had an average of one less ultrasound visit per cycle.Tabled 1OutcomeProvera (n=198)Control (n = 559)P-valueDays of Stimulation9.9 ± 1.510.2 ± 1.70.67Total FSH dose (IU)4103 ± 9704287 ± 9730.41Number of visits4.3 ± 1.05.6 ± 1.2<0.01Max E2 (pg/ml)2933 ±17422679 ± 15330.07Oocytes retrieved14.9 ± 9.913.3 ± 10.00.06Mature oocytes10.7 ± 7.410.3 ± 7.60.13Patients creating embryosProvera (n= 131)Control (n = 427)P-value2PNs8.5 ± 6.07.8 ± 6.40.23Blastocysts5.0 ± 4.34.8 ± 4.80.75Euploid blasts2.7 ± 2.72.5 ± 2.60.87 Open table in a new tab This prospective cohort trial demonstrated that use of the oral progestin analogue, provera, for ovulatory suppression was similar to standard protocols, with no instances of premature ovulation and a similar number of oocytes retrieved. Blastocyst, euploidy and pregnancy rates were also similar between groups. Additionally, there were significant cost savings and fewer visits for patients with oral provera versus standard protocols.