Progestin-primed ovarian stimulation improves the outcomes of IVF/ICSI cycles in infertile women with diminished ovarian reserve

Yu, Chunmei; Dai, Xiuliang; Wang, Yufeng; Gao, Tingting; Cao, Fang; Xia, Xiyang; Chen, Li

doi:10.1097/jcma.0000000000000177

Cited by 18 publications

(22 citation statements)

References 33 publications

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“…In this study, the incidence of premature LH surge rate and LH levels on the trigger day were significantly lower in the PPOS group than in the mild stimulation group, which was similar to the results reported in Peng et al’s study ( 1 ). Another self-controlled study comparing PPOS protocol with clomiphene-primed ovarian stimulation in infertile women with DOR also found that PPOS significantly suppressed the LH surge ( 18 ). It is well known that multi-follicular growth by COS results in increased production of estrogen, which can lead to a sudden LH surge and spontaneous ovulation before oocyte retrieval ( 19 , 20 ).…”

Section: Discussionmentioning

confidence: 96%

Progestin-Primed Ovarian Stimulation Versus Mild Stimulation Protocol in Advanced Age Women With Diminished Ovarian Reserve Undergoing Their First In Vitro Fertilization Cycle: A Retrospective Cohort Study

You

Jing

et al. 2022

Front. Endocrinol.

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ObjectiveTo assess and compare the feasibility of progestin-primed ovarian stimulation (PPOS) protocol with mild stimulation protocol for advanced age women with diminished ovarian reserve (DOR) undergoing their first in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycle.MethodsPatients aged ≥35 years and DOR undergoing their first IVF/ICSI cycle were enrolled in this retrospective cohort study: 139 and 600 patients underwent the PPOS and mild stimulation protocols, respectively. The primary outcomes were cumulative clinical pregnancy rate (CCPR) and cumulative live birth rate (CLBR). The secondary outcomes were the number of oocytes retrieved and top-quality embryos.ResultsThere was nearly no significant difference of baseline characteristics between the two groups. Although a greater amount of total gonadotropin (1906.61 ± 631.04 IU vs. 997.72 ± 705.73 IU, P<0.001) and longer duration of stimulation (9 (10–7) vs. 6 (8–4), P<0.001) were observed in the PPOS group, the number of retrieved oocytes (3 (6–2) vs. 2 (4–1), P<0.001) and top-quality embryos (1 (2–0) vs. 1 (2–0), P=0.038) was greater in the PPOS group than the mild stimulation group. Meanwhile, the incidence of premature luteinizing hormone (LH) surge rate was significantly lower in the PPOS group (0.7% vs.8.3%, P=0.001) than the mild stimulation group. However, there was no significant difference in conservative CCPR, conservative CLBR, optimistic CCPR, and optimistic CLBR between the two groups (all P>0.05). A multivariate logistic regression model showed significant positive effects of the number of retrieved oocytes and number of top-quality embryos on conservative CCPR (OR=1.236, 95%CI: 1.048–1.456, P=0.012, OR=2.313, 95%CI: 1.676–3.194, P<0.001) and conservative CLBR (OR=1.250, 95%CI: 1.036–1.508, P=0.020, OR=2.634, 95%CI: 1.799–3.857, P<0.001) respectively, while significant negative effects of age were identified for conservative CCPR (OR=0.805, 95%CI: 0.739–0.877, P<0.001) and conservative CLBR (OR=0.797, 95%CI: 0.723–0.879, P<0.001).ConclusionThe PPOS protocol is an effective alternative to the mild stimulation protocol for advanced age patients with DOR, as it provides comparable reproductive outcomes and better control of premature LH surge. Further, more oocytes and top-quality embryos were obtained in the PPOS group, which had a positive association with conservative CCPR and CLBR.

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Section: Discussionmentioning

confidence: 96%

Progestin-Primed Ovarian Stimulation Versus Mild Stimulation Protocol in Advanced Age Women With Diminished Ovarian Reserve Undergoing Their First In Vitro Fertilization Cycle: A Retrospective Cohort Study

You

Jing

et al. 2022

Front. Endocrinol.

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“…PPOS protocol. PPOS protocol was performed as we described previously 23 . Medroxyprogesterone acetate (MPA; 6 mg/day; Guang Zhou Xianling Pharmaceutical Co., China) and Gn (150-225 IU; Anhui Fengyuan Pharmaceutical Co., China) were administered from day 3 of menstruation onward until the dominant follicle diameter reached > 18 mm.…”

Section: Methodsmentioning

confidence: 99%

AMH has no role in predicting oocyte quality in women with advanced age undergoing IVF/ICSI cycles

Dai

Wang

Yang

et al. 2020

Sci Rep

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It has been widely acknowledged that anti-Müllerian hormone (AMH) is a golden marker of ovarian reserve. Declined ovarian reserve (DOR), based on experience from reproductive-aged women, refers to both the quantitative and qualitative reduction in oocytes. This view is challenged by a recent study clearly showing that the quality of oocytes is similar in young women undergoing IVF cycles irrespective of the level of AMH. However, it remains elusive whether AMH indicates oocyte quality in women with advanced age (WAA). The aim of this study was to investigate this issue. In the present study, we retrospectively analysed the data generated from a total of 492 IVF/ICSI cycles (from January 2017 to July 2020), and these IVF/ICSI cycles contributed 292 embryo transfer (ET) cycles (from June 2017 to September 2019, data of day 3 ET were included for analysis) in our reproductive centre. Based on the level of AMH, all patients (= > 37 years old) were divided into 2 groups: the AMH high (H) group and the AMH low (L) group. The parameters of in vitro embryo development and clinical outcomes were compared between the two groups. The results showed that women in the L group experienced severe DOR, as demonstrated by a higher rate of primary diagnosis of DOR, lower antral follicle count (AFC), higher level of basal follicle stimulating hormone (FSH) and cancelation cycles, lower level of E2 production on the day of surge, and fewer oocytes and MII oocytes retrieved. Compared with women in the H group, women in the L group showed slightly reduced top embryo formation rate but a similar normal fertilization rate and blastocyst formation rate. More importantly, we found that the rates of implantation, spontaneous miscarriage and livebirth were similar between the two groups, while the pregnancy rate was significantly reduced in the L group compared with the H group. Further analysis indicated that the higher pregnancy rate of women in the H group may be due to more top embryos transferred per cycle. Due to an extremely low implantation potential for transfer of non-top embryos from WAA (= > 37 years old) in our reproductive centre, we assumed that all the embryos that implanted may result from the transfer of top embryos. Based on this observation, we found that the ratio of embryos that successfully implanted or eventually led to a livebirth to top embryos transferred was similar between the H and the L groups. Furthermore, women with clinical pregnancy or livebirth in the H or L group did not show a higher level of serum AMH but were younger than women with non-pregnancy or non-livebirth. Taken together, this study showed that AMH had a limited role in predicting in vitro embryo developmental potential and had no role in predicting the in vivo embryo developmental potential, suggesting that in WAA, AMH should not be used as a marker of oocyte quality. This study supports the view that the accumulation of top embryos via multiple oocyte retrieval times is a good strategy for the treatment of WAA.

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“… 22 , 23 It was shown that the number of retrieved oocytes and high-quality embryos in standard PPOS was significantly higher than that in the group of conventional protocols and mild/minimal stimulation. 8–10 However, several previous studies have indicated that the application of progestin from the beginning of ovarian stimulation may lead to profound pituitary suppression, and the extent of pituitary suppression is directly associated with the total dosage of Gn. 4–6 This was consistent with our results showing that women in standard PPOS exhibited higher rates of profound pituitary suppression and required a higher dosage of Gn per number of oocytes retrieved than those in PPOS+CC, especially for women ≤35 years.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies show that PPOS improves the quantity and quality of oocytes and is a more feasible controlled ovarian stimulation protocol for women with DOR or poor ovarian response compared with conventional protocols and mild/minimal stimulation. 8–10 However, the continuous supply of progestin during PPOS can lead to profound pituitary suppression. 4–6 Profound pituitary suppression is positively correlated with Gn consumption.…”

Section: Introductionmentioning

confidence: 99%

Progestin-Primed Ovarian Stimulation with Clomiphene Citrate Supplementation May Be More Feasible for Young Women with Diminished Ovarian Reserve Compared with Standard Progestin-Primed Ovarian Stimulation: A Retrospective Study

Lin¹,

Chen²,

Zhu³

et al. 2021

DDDT

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Purpose The present study was designed to compare the efficiency of the progestin-primed ovarian stimulation (PPOS) protocol with clomiphene citrate (CC) supplementation (PPOS+CC) and the standard PPOS protocol for women of different ages with diminished ovarian reserve (DOR). Patients and Methods This retrospective cohort study included 364 DOR women who underwent controlled ovarian stimulation with PPOS+CC (n = 223) or standard PPOS (n = 141). They were divided into subgroups based on age: ≤35 years and >35 years. Differences in baseline characteristics, ovarian stimulation characteristics, endocrinological characteristics, and clinical outcome between the two groups were assessed. Statistical analyses were stratified by age. Results In all women with DOR, PPOS+CC was associated with a lower percentage of women with profound pituitary suppression than standard PPOS (0.0% vs 18.6%, P < 0.001 and 1.3% vs 11.0%, P = 0.002). In young women with DOR, more high-quality cleavage-stage embryos were harvested (1.96 vs 1.38, P = 0.018) and a lower dosage of gonadotropin per oocyte retrieved was required (558.37 vs 909.82, P = 0.036) in PPOS+CC. In older women with DOR, PPOS+CC led to an increase in the incidence of luteinizing hormone (LH) surge levels above 10 IU/L on trigger day (12.7% vs 4.9%, P = 0.028) and a decrease in the rate of oocyte maturation (84.7% vs 89.9%, P = 0.034) compared to standard PPOS. Conclusion Clomiphene citrate is an effective adjuvant to alleviate pituitary suppression in PPOS protocols; for young women with DOR, CC supplementation had a positive impact on the number of high-quality embryos. However, older women with DOR would be at risk of developing a premature LH surge and having poor oocyte maturation rate under the PPOS+CC protocol.

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Progestin-primed ovarian stimulation improves the outcomes of IVF/ICSI cycles in infertile women with diminished ovarian reserve

Cited by 18 publications

References 33 publications

Progestin-Primed Ovarian Stimulation Versus Mild Stimulation Protocol in Advanced Age Women With Diminished Ovarian Reserve Undergoing Their First In Vitro Fertilization Cycle: A Retrospective Cohort Study

Progestin-Primed Ovarian Stimulation Versus Mild Stimulation Protocol in Advanced Age Women With Diminished Ovarian Reserve Undergoing Their First In Vitro Fertilization Cycle: A Retrospective Cohort Study

AMH has no role in predicting oocyte quality in women with advanced age undergoing IVF/ICSI cycles

Progestin-Primed Ovarian Stimulation with Clomiphene Citrate Supplementation May Be More Feasible for Young Women with Diminished Ovarian Reserve Compared with Standard Progestin-Primed Ovarian Stimulation: A Retrospective Study

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