Is MPA an oral alternative to prevent an LH surge?

This study examined the use of medroxyprogesterone acetate in the prevention of unwanted hormonal increase during fertility treatment.

In­-vitro fertilization (IVF) is when a male sperm fertilizes the females’ egg in a laboratory dish outside the body, and is implanted into the woman's uterus. Intracytoplasmic sperm injection (ICSI) is similar but a single sperm is injected directly into the egg. With these treatments, women must also undergo controlled ovarian stimulation (COH), during which ovulation is stimulated and eggs are removed from the ovaries.

Luteinizing hormone (LH) is a hormone produced in women at high levels just before ovulation. Because LH triggers ovulation, if it occurs naturally during IVF it can lower the number of oocytes (eggs) to be retrieved. This can result in cancellation of the cycle.

Medroxyprogesterone acetate (MPA) is a hormone used to prevent a surge in LH and is taken orally. Currently a gonadotropin-releasing hormone (GnRH) antagonist is used to prevent the surge, but this is expensive, complex and needs to be injected.

This study examined the use of MPA as an oral alternative to prevent LH surge during COH.

300 females undergoing IVF/ICSI were included in this study. All patients received human menopausal gonadotropin/hMG (Menotropin) to induce ovulation. 150 patients were also treated with MPA. They were given hMG and MPA from the third day of their menstrual cycle. Another 150 patients were part of the control group who were given hMG and daily injections of a GnRH.

The rate of egg retrieval was significantly higher in those receiving MPA compared to the control (70.2% vs. 63.9%). Clinical pregnancy rates (the presence of a gestational sac at 7 weeks after transfer), implantation rates (the number of gestational sacs compared to the number of embryos transferred), and live birth rates did not differ between the groups.

The number of twin pregnancies was higher in the study group than in the short-protocol group (30.9% vs. 19.7%).

This study concluded that oral MPA was as effective as injected GnRH at preventing an LH surge in women undergoing fertility treatment.  

This study was carried out in embryos that were frozen and thawed before implantation, it may not be as effective in IVF where freezing does not occur.

Talk to your physician if you are trying for a baby or undergoing IVF and would like more information.