Dados do Trabalho

Title

Progesterone for Pituitary Blockade in Ovulation Induction: Exploring the Potential Applications

Objective

Infertility affects approximately 186 million people worldwide, with 8 million in Brazil alone. Assisted human reproduction has become a popular option for infertile couples. In conventional assisted reproduction protocols, gonadotropin-releasing hormone (GnRH) analogs are used for pituitary suppression. However, these protocols have limitations, including high medication costs, subcutaneous injections, lengthy stimulation periods, and various side effects. Therefore, there is a need for more convenient and patient-friendly alternatives. The Progesterone-primed Ovarian Stimulation (PPOS) protocol has emerged as a potential substitute for GnRH analogs, and its effectiveness is being evaluated in reproductive medicine.
This scoping review aims to explore the possibilities of using progestagens in ovarian stimulation, including different presentation forms, various protocols, and a comparison of results between conventional methods and those proposed by studies.

Methods

A scoping review was conducted using the MEDLINE (PubMed), Virtual Health Library, and Science Direct databases. The search strategy employed the PICO (Problem: Ovarian stimulation; Intervention: Use of progesterone; Comparison: Various types of progesterone; Outcome: Treatment success) approach. The search terms used included "progesterone," "progestins for pituitary suppression," "progesterone protocol," "progestin-primed ovarian stimulation," and others. Articles published between January 2015 and May 2022 were selected, with no language restrictions applied.

Results

The search yielded 35 relevant studies out of 1,133 initially identified. The evaluated progestins included medroxyprogesterone acetate, dydrogesterone, desogestrel, and micronized natural progesterone in different concentrations. Among the selected studies, 20 were retrospective, 8 were randomized clinical trials, and 7 were prospective studies. Fifteen studies compared the PPOS protocol with protocols using GnRH antagonists, while 6 studies compared it with protocols using GnRH agonists. Additionally, 14 studies evaluated the use of progestins in comparison with other types or dosages of progestins or with clomiphene citrate. The studies involved 11,684 patients with an average age of 30 years, regular menstrual cycles in the past 3 months, and indications for in vitro fertilization.

Conclusion

The reviewed studies demonstrated that progestins are a viable and effective alternative for suppressing the luteinizing hormone peak during controlled ovarian stimulation. They offer numerous advantages, including patient-friendliness, cost-effectiveness, fewer adverse effects, reduced rates of Ovarian Hyperstimulation Syndrome, and comparable outcomes to conventional protocols in terms of the number of obtained oocytes and gestational success.

Keywords

progesterone, in vitro fertilization, pituitary suppression, progestin-primed ovarian stimulation, oocyte retrieval, infertile couple.