Dados do Trabalho

Title

Evaluation of the use of dydrogesterone in the suppression of luteinizing gonadotropic hormone elevation during ovarian stimulation in in vitro fertilization cycles: a comparative analysis.

Objective

During the in vitro fertilization (IVF) process, controlled ovarian stimulation has been considered one of the most critical steps.
Ineffective suppression of the sudden rise in gonadotropic luteinizing hormone (LH) before the trigger moment accounts for 20 to 50% of the reasons for cycle cancellation.
Drug protocols for pituitary blockade during ovarian stimulation are scarce, antagonist analogs of gonadotropin-releasing hormone are the most used, reducing the impact of premature luteinization on IVF cancellation rates.
The primary objective of this study was to establish the incidence of premature LH surge by determining early ovulation the pituitary blockade, with one group using oral dydrogesterone and the other using a gonadotropin-releasing hormone antagonist, resulting in cancellation of the IVF cycle. The secondary objective was to analyze the time from ovarian stimulation to the moment of triggering of oocyte maturation, correlating with age group and with ultrasonographic evaluation and counting of ovarian antral follicles.

Methods

This is a retrospective study carried out in a cohort of patients at the Human Reproduction Center between January 2021 and July 2023. Oocytes from 182 women underwent intracytoplasmic sperm injection and were divided into two groups. We established a descriptive comparative analysis between the group of ovarian stimulation with recombinant gonadotropin (GonalF/Pergoveris®) and flexible suppression with the injectable antagonist (Cetrotide 0.25 mg®) starting when one of the follicles reached 14 mm in average diameter, remaining until the day of onset and the other group using corifolitropin alfa (Elonva®)/recombinant gonadotropin (Pergoveris®) associated with an oral dose of 30 mg of dydrogesterone (Duphaston®), from the second day of the menstrual cycle until triggering.

Results

A comparative analysis of the results between the two protocols was determined. A total of 182 patients aged between 26 and 49 years were allocated, 89 in the antagonist group and 93 in the dydrogesterone group.
In the antagonist group, the mean age was 36.9 years, with a previous antral follicle count of 5.8 follicles and a duration of ovarian stimulation of 11.31 days. In the dydrogesterone group, the mean age was 34.3 years, with 9.9 antral follicles evaluated and an ovarian stimulation period of 11.31 and 13.96 days.
Premature luteinization with early ovulation was observed in 5.37% of women in the antagonist group and none of the women in the dydrogesterone group (0%). However, we observed that women who ovulated early were of advanced maternal age, with a low ovarian reserve and a low response to ovarian stimulation (Poseidon 4).
We observed an extension of time in days from ovarian stimulation to the trigger moment, adding another 3.3 days in the dydrogesterone group, making a total of 12 to 14 days of ovarian stimulation.

Conclusion

The use of dydrogesterone becomes a possible and effective option to prevent premature LH surges during the pituitary block in ovarian stimulation cycles for IVF. Associated with the benefits of reducing financial costs, ease of oral administration, and especially when the transfer of fresh embryos is not intended.

Keywords

pituitary blockade, dydrogesterone, gonadotropin-releasing hormone antagonist, in vitro fertilization, premature luteinization.