Effect of Progestin-primed Ovarian Stimulation Protocol on Outcomes of Aged Infertile Women Who Failed to Get Pregnant in the First IVF/ ICSI Cycle: A Self-controlled Study

Abstract

This study aimed to explore the outcomes of progestin-primed ovarian stimulation protocol (PPOS) in aged infertile women who failed to get pregnant in the first IVF/ICSI-ET cycles with GnRH-a long protocol. A self-controlled study was conducted to retrospectively investigate the clinical outcomes of 104 aged infertile patients who didn't get pregnant in the first IVF/ICSI-ET treatment by stimulating with GnRH-a long protocol (non-PPOS group), and underwent PPOS protocol (PPOS group) in the second cycle between January 2016 and December 2016 in the Center for Reproductive Medicine, Renmin Hospital of Wuhan University. The primary outcomes included clinical pregnancy rate of frozen-thawed embryos transfer (FET) in PPOS group, and good-quality embryo rate in both groups. The secondary outcomes were fertilization rate, egg utilization rate and cycle cancellation rate. The results showed that there were no significant differences in basal follicle stimulating hormone (bFSH), antral follicle count (AFC), duration and total dosage of gonadotropin (Gn), number of oocytes retrieved, intracytoplasmic sperm injection (ICSI) rate, fertilization rate, and cycle cancellation rate between the two groups (P>0.05). However, the oocyte utilization rate and good-quality embryo rate in PPOS group were significantly higher than those in non-PPOS group (P<0.05). By the end of April 2017,62 FET cycles were conducted in PPOS group. The clinical pregnancy rate and embryo implantation rate were 22.58% and 12.70%, respectively. In conclusion, PPOS protocol may provide better clinical outcomes by improving the oocyte utilization rate and good-quality embryo rate for aged infertile patients who failed to get pregnant in the first IVF/ICSI-ET cycles.

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

“…Exogenous progestins are administered orally, as opposed to GnRH antagonists, which are administered SC, and progestins cost much less than the latter (6). However, when a progestin is used for pituitary suppression during ovarian stimulation, fresh ET has to be forfeited and all embryos need to be cryopreserved for transfer in a future cycle, since embryo development and endometrial receptivity are desynchronized by untimely P exposure (7). Progestins can be more advantageous when a fresh ET is not intended, such as planned freeze-all cycles, preimplantation genetic testing cycles, elective oocyte cryopreservation, and stimulation of oocyte donors (8).…”

“…Various progestins have been successfully used to this end, and they all have been started at the beginning of stimulation, that is, cycle day 3, simultaneously with gonadotropin injections (6)(7)(8)(9)(10)(11)(12)(13)(14). However, an LH surge is not imminent that early in a stimulation cycle, and whether progestins can effectively prevent premature ovulation when started later, like in a flexible GnRH antagonist protocol, is unknown.…”

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

“…The oocyte utilization rate and good-quality embryo rate in PPOS cycles were significantly higher. The duration of stimulation, total dosage of gonadotrophin, the number of oocytes retrieved, and fertilization rate were similar between PPOS and long protocols [35].…”

Comparison of Progestin-Primed Ovarian Stimulation Regimen and Antagonist Regimen in Diminished Ovarian Reserve Patients Over 35 Years of Age

“…No difference in the number of oocytes retrieved was observed between PPOS regimen and antagonist regimen in patients with low ovarian response or polycystic ovary syndrome (PCOS) [16,21]. In a study comparing the PPOS regimen with the long regimen in DOR patients over 35 years of age, no difference was found in the number of oocytes retrieved either [22]. However, in this study, the number of follicles in different stages and the number of retrieved oocytes of the antagonist group were all higher than those of the PPOS group.…”