Received August 12, 2021
Accepted February 21, 2022

Objective: To compare the effect of Medroxyprogesterone acetate versus Gonadotropin releasing hormone antagonist for the prevention of premature luteinizing hormone surge in infertile hyper-responder women undergoing controlled ovarian stimulation for in vitro fertilization (IVF) /intracytoplasmic sperm injection (ICSI) cycles. Methods: One hundred infertile hyper-responder women who were candidate for IVF/ ICSI were randomly assigned in two groups. Group 1 was given 20 mg Medroxyprogesterone acetate from day 1 of cycle till trigger day. Group 2 was given GnRH antagonist (injection Cetrorelix 0.25 mg s/c) from the day when the leading follicle reached 14mm till day of trigger for the prevention of premature LH surge (flexible protocol). Serum levels of LH were measured on day 1, day 7 of cycle and day of trigger. The primary outcome measured was the incidence of premature LH surge. Other outcome measures were total number of mature follicles on the day of trigger, total number of mature oocytes retrieved and number of good quality day 3 embryos . Results: Premature luteinizing hormone surge was not observed in both the groups . Mean number of follicles on day of trigger, mean number of M2 oocytes retrieved and mean number of good quality day 3 embryos were comparable in both groups . Conclusions: The results of this study stated that MPA can be an effective alternative to GnRH antagonist for the prevention of premature LH surge in hyper-responder women undergoing COS for IVF. Key words: Medroxyprogesterone acetate, premature LH surge, GnRH antagonist, controlled ovarian stimulation, hyper-responders