Analysis of euploidy rates in preimplantation genetic testing for aneuploidy cycles with progestin-primed versus GnRH agonist/antagonist protocol

Abstract

Background Progestins can suppress endogenous luteinising hormone (LH) secretion from the pituitary gland and have shown similar efficacy in terms of collecting competent oocytes and embryos; however, some inconsistencies have been proposed regarding the quality of embryos collected with the use of progestins. This study aimed to evaluate euploidy rates and pregnancy outcomes in preimplantation genetic testing for aneuploidy (PGT-A) cycles using the progestin-primed ovarian stimulation (PPOS) protocol versus the gonadotropin-releasing hormone (GnRH) agonist/antagonist protocol. Methods This retrospective cohort study included 608 PGT-A cycles: 146 women in the PPOS group, 160 women in the GnRH agonist group, and 302 women in the GnRH antagonist group. This study was performed at the in vitro fertilisation (IVF) centre of Shanghai First Maternity and Infant Hospital between January 2019 and December 2021. Additionally, 267 corresponding first frozen embryo transfer (FET) cycles were analysed to assess pregnancy outcomes. Results The euploid blastocyst rate per injected metaphase II(MII) oocytes (14.60% vs. 14.09% vs. 13.94%) was comparable among the three groups (p > 0.05). No significant differences were observed among the three groups regarding pregnancy outcomes, including biochemical pregnancy, clinical pregnancy, ongoing pregnancy, implantation, miscarriage, ectopic pregnancy, and live birth rates per transfer in the first FET cycles (p > 0.05). Conclusions The PPOS protocol had no negative effect on euploid blastocyst formation, and the pregnancy outcomes in FET cycles using the PPOS protocol were similar to those of the GnRH agonist and antagonist protocols. Trial registration This trial was retrospectively registered

Switching from cetrorelix to dydrogesterone in an IVF cycle - a new strategy for unexpected freeze-all cycles

“…No differences in embryo euploidy rates were reported in a recent publication comparing the PPOS protocol and other GnRH agonist and antagonist protocols ( Wang et al ., 2023 ). When obstetrical and neonatal outcomes were analyzed, no differences were detected comparing several PPOS protocols with either GnRH agonists or antagonists cycles ( Huang et al ., 2019 ).…”

“…Dydrogesterone was chosen in our case firstly because of its properties in preventing the LH surge ( Yu et al ., 2018 ; Iwami et al, 2018 ). Good clinical, obstetrical and neonatal outcomes have also been published in PPOS with dydrogesterone ( Cui et al ., 2021 ; Wang et al ., 2023 ; Huang et al ., 2019 ). Secondly, oral MPA is not a readily available medication in Brazil.…”

The use of corifollitropin alfa in overlapped doses, in a desogestrel-primed ovarian stimulation regimen, as a new protocol towards an extremely patient-friendly approach: a case report

“…22,23 Recent evidence also suggests that PPOS may improve reproductive outcomes of women with diminished ovarian reserve, 24 with no negative effect on embryo ploidy. 25,26 Although MPA is more potent than that observed for dydrogesterone, this molecule has been extensively studied in the last years, due to its wide access as well as the high selectivity for progesterone receptor, and reduced androgenic activity. 10 However, there is still the inconvenience of taking two pills/day, which is a disadvantage comparing to progestagens with similar suppressive action administered in one daily pill; as a matter of fact, oral MPA and chlormadinone are not available in Brazil, so that the one-pill-a-day options to Brazilian women are restricted to MP and DSG, among the molecules tested in literature.…”

Progestin-primed ovarian stimulation

“…Three recent retrospective cohort studies have compared PPOS and GnRH antagonist protocols in a combined total of 7000 cycles [32 ▪ ,34,35]. No difference was found in embryo euploidy rates in any of the three, though the two largest studies detected similar pregnancy outcomes.…”