Approximately %10-15 of couples of reproductive age have infertility issues. Ovulation
induction and in vitro fertilization (IVF) are the main treatments for infertility. With
ovarian stimulation (OS), the efficiency of IVF has been increased by collecting more
than one oocytes and thus providing more embryos. Multifollicular growth in OS may cause
an increase in sex steroids and an early LH peak, thus premature ovulation. Pituitary
suppression with certain drugs has been used to prevent premature ovulation.. Among these
drugs, it has been observed that GnRH agonists can cause down-regulation, hypo-estrogenic
symptoms, ovarian cyst formation and Ovarian Hyperstimulation Syndrome (OHSS), while
antagonists may have side effects such as low oocyte count and high cycle cancellation.
The use of progesterone preparations as an alternative to these drugs recently gained
ground.
Data including age, BMI, the duration of infertility, the type of infertility, antral
follicle count, serum day 3 FSH level, Serum anti-Müllerian hormone level, total
gonadotropin dose, stimulation time, pituitary suppression starting day, duration of
pituitary suppression, premature ovulation, number of total oocyte count, the number of
total M2, the number of PN , the number of Day 5 blast, number of transferred embryos,
endometrial thickness on the day of transfer will be recorded. When the follicle size
reaches 13-14 mm, patients will be randomized into 3 groups. Group 1 (Cetrorelix: n=99,
0.25 mg/day subcutaneously), Group 2 (Medroxyprogesterone Acetate: n=99, 2x5mg/day
orally) and Group 3 (Dydrogesterone: n=99, 3x10 mg/day orally). Human chorionic
gonadotropin (hCG) will be used for trigger when at least 2 follicles' diameter reaches
17-18mm for ovulation. Thirty-six hours after the hCG injection, the patient's oocytes
will be collected. During 2-5 days of embryo culture, embryo quality will be determined
according to D.Gardner criteria (1999). Embryos will be frozen as blast on the 5th day
and transferred to the frozen cycle to be planned within the next month. Clinical
pregnancy rates will be recorded by performing a blood test for on the 12th day after the
procedure.
The aim of this study is to evaluate the results of three different protocols for
prevention of premature ovulation in ovarian stimulation cycles. All patients undergo IVF
cycles are randomly divided in to three groups. The first group is cetrorelix, the second
group is medroxyprogesterone acetate and the third group is dydrogesterone.