Medroxyprogesterone acetate: an effective ovarian stimulant for women with endometriosis?

This study investigated the effects of medroxyprogesterone acetate (MPA) as an ovarian stimulant in women with endometriosis.

They found that MPA was similarly effective as conventional COH protocol and was well tolerated.

Women undergoing fertility treatment may undergo controlled ovarian stimulation (COH). This involves using gonadotrophin-releasing hormone (GnRH) to stimulate the ovary to release oocytes (eggs) that will then undergo in vitro fertilization (IVF). Endometriosis is a condition where the uterine lining develops outside the uterus. It can greatly impact female fertility and make oocyte harvest more difficult.

Endometriosis is usually treated with drugs called progestins. Progestins reduce levels of estrogen which is known to cause endometriosis. Some studies suggest progestins may be effective in COH and yield higher quality oocytes. Medroxyprogesterone acetate (MPA) is drug that acts like progestin without some negative effects of progestin drugs. Some studies suggest it is effective for COH in combination with human menopausal gonadotrophin (hMG).

This study investigated if MPA and hMG is effective during COH in patients with severe endometriosis.

This study included data from 224 patients with severe endometriosis. Patients were treated using 3 strategies. One group underwent surgery for removal of endometriomas (a mass of endometrial tissue) followed by treatment with MPA and hMG. Another group underwent aspiration (oocyte harvest) and removal of endometriomas without surgery, followed by MPA and hMG. The other group underwent a ‘short’ protocol of COH. Fertilization and pregnancy rates were then compared.

The quality and number of viable oocytes did not differ between the groups. Fertilization rates and pregnancy outcomes were also similar between MPA and conventional COH. No adverse events reported in patients who were treated with MPA. 

This study concluded that MPA was similarly effective as conventional COH protocol and was well tolerated.

This was a retrospective study. The authors could not discern the precise stage of endometriosis in the aspiration group. Disease stage may be an important consideration for the suitability of MPA for certain patients. 

If you have any concerns regarding controlled ovarian hyperstimulation and endometriosis, please discuss with your physician.