Schickler Robyn, Crabtree-Sokol Diana, Patel Jasmine, Bender Nicole, Nelson Anita L, Nguyen Brian T
University of Southern California, Department of Obstetrics and Gynecology, Section of Family Planning, 2020 Zonal Ave Room 220, Los Angeles, CA, 90033, United States.
Western University of Health Sciences, Department of Obstetrics and Gynecology, 1457 3rd St., Manhattan Beach, CA 90266-6335, United States.
Contracept X. 2020 Dec 3;3:100050. doi: 10.1016/j.conx.2020.100050. eCollection 2021.
To examine the rate of ovulatory disruption when intramuscular depot medroxyprogesterone acetate (DMPA) is administered across graded stages of dominant follicle development.
We assigned enrolled participants to one of three preassigned dominant follicle size groups: 12-14 mm, 15-17 mm and ≥ 18 mm. We followed dominant follicles via serial transvaginal ultrasound (TVUS) until the follicles reached their assigned size, at which time we administered DMPA. For 5 consecutive days thereafter, we followed the follicles via TVUS to observe follicle rupture and obtained serum luteinizing hormone (LH), estradiol, and progesterone concentrations. In the following 2 weeks, we collected serum progesterone concentrations twice weekly to detect possible ovulatory delay or dysfunction. We also collected serum medroxyprogesterone acetate (MPA) concentrations at 1 and 24 h after DMPA administration to examine against ovulatory outcomes.
Twenty-six of 29 enrolled women completed the study. DMPA suppressed ovulation in 17/26 (65%) and caused ovulatory dysfunction in 1/26 (4%) participants. Larger follicles were more likely to rupture despite DMPA (12-14 mm: 0/10 (0%); 15-17 mm: 3/10 (30%); ≥ 18 mm: 6/6 (100%); p < .01). Pre-DMPA LH concentrations ranged from 13.8 to 93.7 IU/L (mean 49.0 IU/L) in cases of follicle rupture. We observed no cases of follicle rupture when DMPA was administered through cycle day 12. All 24-h MPA concentrations exceeded those needed for ovulation suppression.
DMPA suppressed and additionally disrupted ovulation in 65% and 4% of observed cycles, respectively. DMPA may provide effective emergency contraception as well as ongoing contraception if administered prior to an expected ovulation and specifically before the LH surge.
DMPA may be an alternative form of emergency contraception that can also self-bridge to ongoing contraception. As ovulation was not observed among any follicles when DMPA was given through cycle day 12, women who initiate DMPA up through cycle day 12 may not require backup contraception.
研究在优势卵泡发育的不同阶段注射醋酸甲羟孕酮长效避孕针（DMPA）时排卵受干扰的发生率。
我们将入选的参与者分配到三个预先设定的优势卵泡大小组之一：12 - 14毫米、15 - 17毫米和≥18毫米。通过连续经阴道超声（TVUS）跟踪优势卵泡，直到卵泡达到其分配的大小，此时给予DMPA。此后连续5天，通过TVUS跟踪卵泡以观察卵泡破裂情况，并测定血清促黄体生成素（LH）、雌二醇和孕酮浓度。在接下来的2周内，每周两次采集血清孕酮浓度以检测可能的排卵延迟或功能障碍。我们还在注射DMPA后1小时和24小时采集血清醋酸甲羟孕酮（MPA）浓度，以研究其与排卵结果的关系。
29名入选女性中有26名完成了研究。DMPA在17/26（65%）的参与者中抑制了排卵，在1/26（4%）的参与者中导致排卵功能障碍。尽管使用了DMPA，较大的卵泡更有可能破裂（12 - 14毫米：0/10（0%）；15 - 17毫米：3/10（30%）；≥18毫米：6/6（100%）；p<0.01）。在卵泡破裂的情况下，注射DMPA前LH浓度范围为13.8至93.7IU/L（平均49.0IU/L）。当在月经周期第12天之前注射DMPA时，未观察到卵泡破裂的情况。所有24小时MPA浓度均超过抑制排卵所需的浓度。
DMPA分别在65%和4%的观察周期中抑制并额外干扰了排卵。如果在预期排卵之前，特别是在LH峰之前给予DMPA，它可能提供有效的紧急避孕以及持续避孕。
DMPA可能是一种紧急避孕的替代形式，也可以自行过渡到持续避孕。由于在月经周期第12天之前给予DMPA时未观察到任何卵泡排卵，在月经周期第12天之前开始使用DMPA的女性可能不需要备用避孕措施。
