Ovarian Stimulation and Oocyte Cryopreservation in a Patient Receiving Depot Medroxyprogesterone Acetate

Objective: To evaluate ovarian stimulation outcomes and trigger strategy in a patient undergoing fertility preservation while receiving depot medroxyprogesterone acetate (DMPA). Design: Single-patient case report. Materials and Methods: A 35-year-old gravida 1 para 0010 on DMPA for 22 months presented for elective oocyte cryopreservation. Her last injection was 7 weeks prior to stimulation. Baseline ovarian reserve demonstrated antimüllerian hormone (AMH) 2.49 ng/mL, follicle-stimulating hormone (FSH) 11 mIU/mL, luteinizing hormone (LH) 5.2 mIU/mL, estradiol (E2) 27.8 pg/mL, antral follicle count (AFC) 26, and body mass index (BMI) 40 kg/m². A gonadotropin-releasing hormone (GnRH) antagonist protocol was initiated using recombinant FSH and human menopausal gonadotropin, with GnRH antagonist added during follicular development. Final oocyte maturation was triggered with 10,000 IU human chorionic gonadotropin (hCG). Results: Despite hypothalamic–pituitary suppression, the patient demonstrated robust follicular response with peak E2 of 3755 pg/mL and 21 follicles ≥12 mm. A total of 25 oocytes were retrieved, of which 22 were mature (metaphase II) and vitrified. The patient experienced mild ovarian hyperstimulation syndrome (OHSS), managed conservatively without hospitalization. While GnRH antagonist protocols typically utilize a GnRH agonist (leuprolide acetate) trigger with or without low-dose hCG to reduce OHSS risk, a full-dose hCG trigger was selected due to concern for suppressed endogenous LH levels in the setting of recent DMPA use. Conclusions: This case demonstrates that ovarian stimulation and oocyte cryopreservation may be feasible within weeks of DMPA administration without a prolonged washout period. Suppression of endogenous LH may influence trigger selection, with potential implications for OHSS risk. Further studies are needed to define optimal stimulation strategies in this population.