Comparison of the Cumulative Live Birth Rates of Progestin-Primed Ovarian Stimulation and Flexible GnRH Antagonist Protocols in Patients With Low Prognosis

Du, Muying; Zhang, Junwei; Li, Zhen; Xin-mi, Liu; Li, Jing; Liu, Wenxia; Guan, Yichun

doi:10.3389/fendo.2021.705264

Cited by 30 publications

(38 citation statements)

References 34 publications

(60 reference statements)

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“…Meanwhile, no statistically signi cant differences were found in Gn dosage, duration of ovarian stimulation, number of oocytes retrieved, number of 2PN embryos and CLBR between the PPOS and GnRH-Ant groups [13]. In accord with the previous research [17], the high cancellation rates were found in patients treated with the PPOS and GnRH-Ant regimens, especially patients in PPOS regimen.…”

Section: Discussionsupporting

confidence: 81%

“…For POSEIDON Group Another study for patients of POSEIDON Group 3 have found that GnRH-Ant group had higher LH levels on trigger day (5.1 ± 4.7 mIU/ml vs. 3.5 ± 2.4 mIU/ml, P = 0.08) and less available embryos (0.9 ± 0.8 vs. 1.2 ± 1.1, P = 0.07) than PPOS group, but without signi cant difference [13].…”

Section: Discussionmentioning

confidence: 93%

“…PPOS in all POSEIDON subgroups and signi cantly higher in Group 4 with POR patients aged ≥ 35 years [12]. However, another study showed no difference in CLBR between PPOS regimen and GnRH-Ant regimen in POR population [13].…”

Section: Methodsmentioning

confidence: 90%

“…The secondary outcome measures were number of oocytes retrieved, duration of gonadotropin (Gn) treatment, amount of Gn administered, fertilization rates, chemical and clinical pregnancy.PPOS in all POSEIDON subgroups and signi cantly higher in Group 4 with POR patients aged ≥ 35 years [12]. However, another study showed no difference in CLBR between PPOS regimen and GnRH-Ant regimen in POR population [13].In the present study, we retrospectively analyzed the e ciency of the PPOS, GnRH-Ant and GnRH-a protocols for patients in POSEIDON Group 3 with low AMH (< 1.2 ng/mL)/low AFC (< 5 follicles) and less than 35 years old. The live birth rate (LBR) was the primary outcome.…”

mentioning

confidence: 89%

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Comparison of Live Birth Rate Among PPOS, GnRH Antagonist and GnRH Agonist in POSEIDON Group 3

Gui

Chen

Liu

et al. 2022

Preprint

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Background It is difficult to select an ovarian stimulation protocol for the patients with poor ovarian reserve (POR) because few oocytes are retrieved in a single controlled ovarian stimulation (COS) cycle. The aim of this study was to compare the pregnancy outcomes of different protocols in POSEIDON Group 3 patients. Methods This was a retrospective cohort study. Patients met the POSEIDON Group 3 criteria who underwent assisted reproductive technology at the Reproductive center of Renmin Hospital of Wuhan University between April 2019 and August 2021 were included. The COS protocols included progestin-primed ovarian stimulation (PPOS), GnRH antagonist and GnRH agonist protocols. The live birth rate (LBR) was the primary outcome. The secondary outcome measures were number of oocytes retrieved, duration of gonadotropin (Gn) treatment, amount of Gn administered, fertilization rates, chemical and clinical pregnancy. Results A total of 309 women met the POSEIDON Group 3 criteria were included for analysis. When compared with PPOS group and GnRH antagonist group, anti-Mullerian hormone, antral follicle count and oocytes retrieved were significantly higher in GnRH agonist group (P = 0.021; P < 0.001; P < 0.001); the basal FSH value was significantly lower in GnRH agonist group (P = 0.006); the estradiol values on trigger day and growth hormone utilization rate were significantly increased in GnRH agonist group (P < 0.001; P = 0.001). However, there was no significant difference in the outcomes of embryos, without significant difference in 2 pronuclear rate, transplantable embryo rate and high-quality embryo rate among the three groups. There was also no significant difference in pregnancy outcomes, although the clinical pregnancy rate (61% vs.51.2% vs.44.9%) and LBR (33.3% vs.23.3% vs.23.2%) were higher in GnRH agonist group than PPOS and GnRH antagonist groups, but not statistically significant. The chemical pregnancy rate was significantly higher in GnRH agonist group than GnRH antagonist group (80.5% vs. 56.7%, P = 0.008). LH values on trigger day were significantly higher in GnRH antagonist group than the other two groups (P < 0.001). The cycle cancellation rate and miscarriage rate were highest in PPOS group, but without significant difference. Conclusion For patients with POR diagnosed as POSEIDON Group 3, the LBR is comparable among the PPOS, GnRH antagonist and GnRH agonist protocols. Considering the economic cost and the prevalence of COVID-19, it is recommended to use the short COS regimens with fresh embryo transplantation.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 93%

Section: Methodsmentioning

confidence: 90%

mentioning

confidence: 89%

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Comparison of Live Birth Rate Among PPOS, GnRH Antagonist and GnRH Agonist in POSEIDON Group 3

Gui

Chen

Liu

et al. 2022

Preprint

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“…By competing with endogenous GnRH for pituitary cell GnRH receptors, GnRH antagonists regulate pituitary surface GnRH receptor levels, inhibit early LH peaks and endogenous FSH and LH levels, more closely resemble the development of follicles under normal physiological conditions, prevent early follicular luteinization or ovulation, and result in more highquality eggs (12). PPOS (13) The European Society of Human (15) for patients with a low prognosis diagnosed according to the POSEIDON criteria, the CLBR of the PPOS regimen was comparable to that of the GnRH antagonist regimen. In contrast with the PPOS regimen, which supports fresh embryo transfer, the PPOS regimen must be combined with total freezing and delayed embryo transfer; therefore, the antagonist regimen significantly reduces the time to clinical pregnancy, consistent with the data from this trial, and the reduction in TTP may reduce patient anxiety to some extent (16).…”

Section: Discussionmentioning

confidence: 99%

Analysis of cumulative live birth rate and perinatal outcomes in young patients with low anti-müllerian hormone levels using two ovulation promotion protocols: A cohort study

Jia

Wang

et al. 2022

Front. Endocrinol.

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ObjectiveTo compare cumulative live birth rates and perinatal outcomes of young IVF/ICSI patients with low anti-Mullerian hormone (AMH) levels on a gonadotropin-releasing hormone antagonist (GnRH-ant) regimen with those on a high progesterone state of ovulation (PPOS) regimen.MethodsWe retrospectively analyzed 798 patients who underwent in vitro fertilization (IVF) or intracytoplasmic sperm microinjection (ICSI) between January 2015 and December 2020 at the Third Affiliated Hospital of Zhengzhou University. A total of 798 cycles of complete clinical data from patients who underwent in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) at the Reproductive Medicine Center of Zhengzhou University Hospital between January 2015 and December 2020 and were eligible for AMH < 1.2 ng/ml at age < 35 years, Group A1: very low AMH levels (AMH < 0.5 ng/mL) and GnRH antagonist regimen; Group A2, very low AMH level (AMH < 0.5 ng/mL) and PPOS regimen; Group B1, low AMH level (0.5 ng/mL ≤ AMH < 1.2 ng/mL) and GnRH antagonist regimen; and Group B2, low AMH level (0.5 ng/mL ≤ AMH < 1.2 ng/mL), and the PPOS regimen.ResultsAt very low levels of AMH (< 0.5 ng/mL), the CLBR of the GnRH antagonist regimen was not significantly different from that of the PPOS regimen (P > 0.05), at 0.5 ng/mL ≤ AMH < 1.2 ng/mL. Statistics showed that the CLBR of the GnRH antagonist regimen was significantly higher than that of the PPOS regimen (49.7% vs. 35.7%, P=0.002). Logistic regression analysis showed that in Group A: the younger the female partner, the higher the CLBR (OR = 0.972, 95% CI = 0.923–1.042, P = 0.022), and the more the AFC, the higher the CLBR (OR = 1.166, 95% CI = 1.091–1.336, P < 0.001). Group B: the higher the number of good-quality embryos, the higher the CLBR (OR = 2.227, 95% CI = 1.869–2.654, P < 0.001). Compared with PPOS regimens, the antagonist regimen was able to increase the CLBR. The analysis of Group A showed that the antagonist regimen had a shorter TTP than the PPOS regimen (P < 0.001); however, the PPOS regimen had a lower cost of ovulation (4311.91 vs. 4903.81, P = 0.023). The antagonist regimen in Group B had a shorter TTP than the PPOS regimen, and there was no significant difference in the cost of ovulation. In the analysis of perinatal outcomes, there were no statistically significant differences in preterm birth, low birth weight, very low birth weight, and pregnancy complications among the four groups.ConclusionYoung patients with very low AMH levels (< 0. 5 ng/mL), the GnRH antagonist regimen was comparable to the PPOS regimen in CLBR outcomes; the antagonist regimen shortens the time to clinical pregnancy, and the PPOS regimen is more cost-effective. In young patients with low AMH levels of 0.5 ng/mL and <1.2 ng/mL, the GnRH antagonist regimen can more appropriate to improve CLBR, and the perinatal outcomes were similar for both regimens.

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Comparison of fixed and flexible progestin-primed ovarian stimulation protocols to prevent premature luteinization in patients with diminished ovarian reserve

Durdağ

Aytaç

Yağınç

et al. 2023

Arch Gynecol Obstet

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Comparison of the Cumulative Live Birth Rates of Progestin-Primed Ovarian Stimulation and Flexible GnRH Antagonist Protocols in Patients With Low Prognosis

Cited by 30 publications

References 34 publications

Comparison of Live Birth Rate Among PPOS, GnRH Antagonist and GnRH Agonist in POSEIDON Group 3

Comparison of Live Birth Rate Among PPOS, GnRH Antagonist and GnRH Agonist in POSEIDON Group 3

Analysis of cumulative live birth rate and perinatal outcomes in young patients with low anti-müllerian hormone levels using two ovulation promotion protocols: A cohort study

Comparison of fixed and flexible progestin-primed ovarian stimulation protocols to prevent premature luteinization in patients with diminished ovarian reserve

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