Comparison of a novel flexible progestin primed ovarian stimulation protocol and the flexible gonadotropin-releasing hormone antagonist protocol for assisted reproductive technology

Abstract

Objective: To determine whether a flexible progestin primed ovarian stimulation (fPPOS) protocol is effective for preventing premature ovulation. Design: Retrospective cohort study. Setting: Private assisted reproduction center. Patient(s): Eighty-seven oocyte donors and 191 recipients of fresh oocytes. Intervention(s): Each donor was stimulated with a flexible gonadotropin-releasing hormone (GnRH) antagonist protocol in one cycle and with the new fPPOS protocol in the other, within a period of 6 months. FSH was started on cycle day 2-3, and 0.25 mg/day GnRH antagonist or 10 mg/ day medroxyprogesterone acetate (MPA) was started on stimulation day 7 or when the leading follicle reached 14 mm, whichever came first. Main Outcome Measure(s): Duration of stimulation, gonadotropin consumption, duration of GnRH antagonist or MPA administration, number of metaphase II oocytes, and pregnancy rates in fresh oocyte recipients. Results: Duration of stimulation was 11 (10-11) days in both groups. Total gonadotropin consumption was similar. Pituitary suppression was started on day 7 and lasted for 5 days in each group. There were no premature ovulations in any group. The fPPOS yielded a significantly higher number of cumulus oocyte complexes than GnRH antagonist cycles (33 [21-39] vs. 26 [18-36], respectively). Likewise, the fPPOS generated significantly more metaphase II oocytes than GnRH antagonist cycles (24 [17-34] vs. 21 [15-28], respectively). Recipients of fresh oocytes from fPPOS and GnRH antagonist cycles had similar cleavage, blastulation, implantation, and live birth/ongoing pregnancy rates (50% vs. 48.6%). Conclusion(s): FPPOS with MPA seems to be an effective choice for preventing premature ovulation in women undergoing ovarian stimulation without compromising oocyte quality. (Fertil Steril Ò 2019;112:677-83. Ó2019 by American Society for Reproductive Medicine.) El resumen está disponible en Español al final del artículo.

The best execution of the DuoStim strategy (double stimulation in the follicular and luteal phase of the same ovarian cycle) in patients who are poor ovarian responders

“…There has been controversy about whether the use of MPA in the PPOS program will affect the outcome of pregnancy. However, the literature in recent years has all related to the safety and effectiveness of the PPOS scheme [38]. It is suggested that the numbers of blastocysts and euploid blastocysts per patient and the number of euploid embryos per injected oocyte are similar for patients undergoing the PPOS program and for those undergoing COS with GnRH antagonists [39].…”

Dydrogesterone‐primed ovarian stimulation is an effective alternative to gonadotropin‐releasing hormone antagonist protocol for freeze‐all cycles in polycystic ovary syndrome

“…Interestingly, a few studies have also compared the antagonist protocol with PPOS. 15,30,31 Iwami et al compared the antagonist protocol and PPOS and obtained similar results in normo-responsive patients. 15 Begueria et al performed a non-inferiority trial to compare MPA and GnRH antagonist with regard to the number of mature oocytes retrieved in oocyte donation cycles, and reported no differences in the number of mature oocytes, length of stimulation, fertilization rate, or quality of embryos between the two treatments.…”

“…They reported similar cleavage, blastulation, implantation and live birth rates in both groups. 31 Most studies have included normo-responsive patients. 18,25 However, hyper-responsive patients may be the most suitable population for this protocol because freeze-all is the current standard of care for preventing OHSS in these patients.…”

Validation of an extremely patient-friendly progestin-primed ovarian stimulation protocol in normal and high responders by comparing with conventional antagonist protocol: a retrospective study

“…According to previous investigation, the fertility potential of oocytes collected in the presence of exogenous progestogen, regardless of MPA [8,12], dydrogesterone [10,27,34], or utrogestan [9,13,36], are as competent as those collected via conventional stimulation protocols. An interesting big data revealed no difference in the reproductive outcome of the oocytes induced in the presence or absence of levonorgestrel-releasing intrauterine device [37].…”

“…Recipients of fresh oocytes from fPPOS and GnRH antagonist cycles had similar cleavage, implantation, and live birth/ongoing pregnancy rates [34]. As to PPOS versus long protocol which suppresses pituitary function much more than short and antagonist protocol, there was a retrospective self-controlled study conducted on 104 aged infertile patients who failed in their first IVF/ICSI attempt by means of long protocol.…”