Effects of progestin-primed ovarian stimulation protocol plus clomiphene citrate in patients with low basal LH levels: a randomized controlled trial
- 1Department of Assisted Reproduction, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Rd, Shanghai, 200011 China
Abstract
Background: Infertile patients with low basal luteinizing hormone (LH) levels have low oocyte retrieval rate, but whether progestin-primed ovarian stimulation (PPOS) protocol with clomiphene citrate (CC) could enhance oocyte retrieval rate in these patients remains unclear.
Methods: This prospective randomized controlled trial was performed between January 2018 and February 2021, included 230 infertile patients with low basal LH levels (LH < 2.27 mIU/mL). In study group, 115 patients received human menopausal gonadotropin (hMG) 150 or 225 IU/d + CC 50 mg/d + medroxyprogesterone acetate (MPA) 10 mg/d from the third day of menstruation. In control group, 115 patients received hMG 150 or 225 IU/d + MPA 10 mg/d from the third day of menstruation. Viable embryos were cryopreserved for later transfer. The primary outcome measure was the oocyte retrieval rate.
Results: CC contributed to LH secretion. The hMG+MPA+CC group showed a decreased oocyte retrieval rate (0.71 ± 0.22 vs. 0.76 ± 0.18, mean difference (MD) -0.06 (-0.11 to -0.01); P = 0.043) and a decreased number of cryopreserved embryos (2.89 ± 2.43 vs. 3.90 ± 2.39, MD -0.89 (-1.50 to -0.28); FDR-P = 0.035). Two groups had similar number of retrieved oocytes (8.83 ± 5.41 vs. 10.69 ± 5.85, MD -0.99 (-2.27 to 0.29); FDR-P = 0.213) and oocyte utilization rate (0.40 ± 0.25 vs. 0.46 ± 0.24, MD -0.07 (-0.14 to -0.01); FDR-P = 0.084). Two groups had comparable cumulative clinical pregnancy rates (61.05% vs. 77.67%, hazard ratio (HR) 0.74 (0.53 to 1.06); P = 0.101; FDR-P = 0.214) and cumulative live birth rates (53.68% vs. 66.02%, HR 0.77 (0.53 to 1.13); P = 0.183; FDR-P = 0.214).
Conclusions: CC contributed to LH secretion, but PPOS protocol with CC resulted in a lower oocyte retrieval rate in patients with low basal LH levels. PPOS protocol with CC should be used cautiously in these patients.
Trial registration: ChiCTR number: ChiCTR1800014440. URL: https://www.chictr.org.cn/showproj.html?proj=24573. Date of registration: 2018/01/13. Date of enrollment of the first subject: 2018/1/17.
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BibTeX
@article{hu2026effects,
title = {{Effects of progestin-primed ovarian stimulation protocol plus clomiphene citrate in patients with low basal LH levels: a randomized controlled trial}},
author = {Zhijie Hu and Yong Fan and Xiaoqian Zhou and Haiyan Guo and Weiran Chai and Qiuju Chen and Qifeng Lyu and Renfei Cai and Xuefeng Lu},
journal = {Reproductive Biology and Endocrinology : RB\&E},
year = {2026},
month = aug,
doi = {10.1186/s12958-026-01601-5},
url = {https://doi.org/10.1186/s12958-026-01601-5},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Effects of progestin-primed ovarian stimulation protocol plus clomiphene citrate in patients with low basal LH levels: a randomized controlled trial
AU - Zhijie Hu
AU - Yong Fan
AU - Xiaoqian Zhou
AU - Haiyan Guo
AU - Weiran Chai
AU - Qiuju Chen
AU - Qifeng Lyu
AU - Renfei Cai
AU - Xuefeng Lu
PY - 2026
DA - 2026/08/06
JO - Reproductive Biology and Endocrinology : RB&E
DO - 10.1186/s12958-026-01601-5
UR - https://doi.org/10.1186/s12958-026-01601-5
AB - Background: Infertile patients with low basal luteinizing hormone (LH) levels have low oocyte retrieval rate, but whether progestin-primed ovarian stimulation (PPOS) protocol with clomiphene citrate (CC) could enhance oocyte retrieval rate in these patients remains unclear. Methods: This prospective randomized controlled trial was performed between January 2018 and February 2021, included 230 infertile patients with low basal LH levels (LH < 2.27 mIU/mL). In study group, 115 patients received human menopausal gonadotropin (hMG) 150 or 225 IU/d + CC 50 mg/d + medroxyprogesterone acetate (MPA) 10 mg/d from the third day of menstruation. In control group, 115 patients received hMG 150 or 225 IU/d + MPA 10 mg/d from the third day of menstruation. Viable embryos were cryopreserved for later transfer. The primary outcome measure was the oocyte retrieval rate. Results: CC contributed to LH secretion. The hMG+MPA+CC group showed a decreased oocyte retrieval rate (0.71 ± 0.22 vs. 0.76 ± 0.18, mean difference (MD) -0.06 (-0.11 to -0.01); P = 0.043) and a decreased number of cryopreserved embryos (2.89 ± 2.43 vs. 3.90 ± 2.39, MD -0.89 (-1.50 to -0.28); FDR-P = 0.035). Two groups had similar number of retrieved oocytes (8.83 ± 5.41 vs. 10.69 ± 5.85, MD -0.99 (-2.27 to 0.29); FDR-P = 0.213) and oocyte utilization rate (0.40 ± 0.25 vs. 0.46 ± 0.24, MD -0.07 (-0.14 to -0.01); FDR-P = 0.084). Two groups had comparable cumulative clinical pregnancy rates (61.05% vs. 77.67%, hazard ratio (HR) 0.74 (0.53 to 1.06); P = 0.101; FDR-P = 0.214) and cumulative live birth rates (53.68% vs. 66.02%, HR 0.77 (0.53 to 1.13); P = 0.183; FDR-P = 0.214). Conclusions: CC contributed to LH secretion, but PPOS protocol with CC resulted in a lower oocyte retrieval rate in patients with low basal LH levels. PPOS protocol with CC should be used cautiously in these patients. Trial registration: ChiCTR number: ChiCTR1800014440. URL: https://www.chictr.org.cn/showproj.html?proj=24573. Date of registration: 2018/01/13. Date of enrollment of the first subject: 2018/1/17.
SN - 1477-7827
ER -