Comparison Between PPOS and GnRHa-Long Protocol in Clinical Outcome with the First IVF/ICSI Cycle: A Randomized Clinical Trial

Overview

Journal Clin Epidemiol

Publisher Dove Medical Press

Specialty Public Health

Date 2020 Mar 19

PMID 32184672

Citations 15

Authors

Qianwen Xi

Yu Tao

Meiting Qiu

Yun Wang

Yanping Kuang

Affiliations

Soon will be listed here.

Abstract

Purpose: To investigate whether progestin-primed ovarian stimulation (PPOS) can be an alternative as gonadotrophin-releasing hormone agonist (GnRHa) long protocol for infertile women with normal ovarian reserve during IVF/ICSI.

Methods: A prospective randomized controlled trial (RCT) including 257 patients was conducted between 1 August 2017 to 1 January 2018. Computerized randomization was performed to assign participants into two treatment groups at a 1:1 ratio: PPOS (130 patients) or GnRHa long protocol (127 patients) followed by their first IVF/ICSI with fresh/frozen embryo transfer. The primary outcome was the number of oocytes retrieved. Patients with normal ovarian reserve undergoing their first IVF/ICSI procedure were included. The embryological and clinical outcomes were measured. Only the first embryo transfer cycle was followed-up.

Results: Basic characteristics such as infertility duration, age, and body mass index (BMI) were comparable in both groups. No significant difference was found in the number (mean ± SD) oocytes retrieved [11.8 ± 6.5 for PPOS vs 11.3 ± 5.6 for GnRHa long protocol] or viable embryos [4.5 ± 3.0 for PPOS vs 4.2 ± 2.9 for GnRHa long protocol] between the groups. No patient from either group experienced a premature LH surge during the whole process of ovarian stimulation. Besides, there was no moderate or severe ovarian hyperstimulation syndrome during the ovarian stimulation in PPOS group while three patients suffered it in the GnRHa long protocol group. There was no significant difference in the clinical pregnancy rate of the first embryos transfer cycle between the two groups.

Conclusion: PPOS in combination with embryo cryopreservation as an ovarian stimulation regimen was as effective as GnRHa long protocol during controlled ovarian stimulation (COH) under different endocrinal mechanisms. It can also achieve comparable embryological and clinical outcomes while reducing the incidence of moderate and severe ovarian hyperstimulation syndrome (OHSS) and HMG dosage. It can be an alternative of the treatments for infertile patients with normal ovarian reserve undergoing IVF as well as traditional protocols.

Trial Registration Number: ChiCTR-INR-17012089.

Trial Registration Date: Chictr.org.cn: 23 July 2017.

Date Of First Patient’s Enrollment: 1 August 2017.

Citing Articles

The PPOS protocol mitigates the detrimental effects of high BMI on embryo and clinical pregnancy outcomes.

Shen X, Li M, Nie Y, Si J, Liu Y, Wang T Reprod Biol Endocrinol. 2024; 22(1):124.

PMID: 39402566 PMC: 11472598. DOI: 10.1186/s12958-024-01294-8.

Economic evaluation of GnRH-agonist long protocol and GnRH-antagonist protocol in IVT/ICSI among the Chinese population: using pharmacoeconomic models.

Si Y, Chen C, Tang Y, Zhang M, Tang J, Pu K BMJ Open. 2024; 14(8):e079715.

PMID: 39153788 PMC: 11331823. DOI: 10.1136/bmjopen-2023-079715.

Effect of medroxyprogesterone acetate dose in progestin-primed ovarian stimulation on pregnancy outcomes in poor ovarian response patients with different body mass index levels.

Zhang Q, He S, Meng Y, Yin T, Ming L, Yang J Front Endocrinol (Lausanne). 2024; 15:1352522.

PMID: 38699386 PMC: 11063298. DOI: 10.3389/fendo.2024.1352522.

Implications of Progestin-Primed Ovarian Stimulation (PPOS) in a Patient With Diminished Ovarian Reserve (DOR) and Its In Vitro Fertilization (IVF) Outcome.

Mahajan S, More A, Dutta S, Shrivastava J, Nawale N, Choudhary N Cureus. 2024; 16(2):e54743.

PMID: 38523966 PMC: 10960963. DOI: 10.7759/cureus.54743.

Comparison of progesterone protocol versus gonadotropin-releasing hormone antagonist protocol in terms of preventing premature LH surge and assisted reproductive technology outcome in infertile women: a randomized controlled trial.

Jabarpour M, Pouri S, Aleyasin A, Shabani Nashtaei M, Najafian A Arch Gynecol Obstet. 2024; 309(5):1999-2008.

PMID: 38421423 DOI: 10.1007/s00404-024-07387-4.

References

. Ovarian hyperstimulation syndrome. Fertil Steril. 2008; 90(5 Suppl):S188-93. DOI: 10.1016/j.fertnstert.2008.08.034. View

Yu S, Long H, Chang H, Liu Y, Gao H, Zhu J . New application of dydrogesterone as a part of a progestin-primed ovarian stimulation protocol for IVF: a randomized controlled trial including 516 first IVF/ICSI cycles. Hum Reprod. 2018; 33(2):229-237. DOI: 10.1093/humrep/dex367. View

Orvieto R . Triggering final follicular maturation--hCG, GnRH-agonist or both, when and to whom?. J Ovarian Res. 2015; 8:60. PMC: 4546254. DOI: 10.1186/s13048-015-0187-6. View

Ren J, Sha A, Han D, Li P, Geng J, Ma C . Does prolonged pituitary down-regulation with gonadotropin-releasing hormone agonist improve the live-birth rate in in vitro fertilization treatment?. Fertil Steril. 2014; 102(1):75-81. DOI: 10.1016/j.fertnstert.2014.03.030. View

Caspi E, Ron-El R, Golan A, Nachum H, Herman A, Soffer Y . Results of in vitro fertilization and embryo transfer by combined long-acting gonadotropin-releasing hormone analog D-Trp-6-luteinizing hormone-releasing hormone and gonadotropins. Fertil Steril. 1989; 51(1):95-9. DOI: 10.1016/s0015-0282(16)60435-1. View

Albuquerque L, Saconato H, Maciel M . Depot versus daily administration of gonadotrophin releasing hormone agonist protocols for pituitary desensitization in assisted reproduction cycles. Cochrane Database Syst Rev. 2005; (1):CD002808. DOI: 10.1002/14651858.CD002808.pub2. View

Abdalla H, Brinsden P, HOWE D, Okonofua F, Craft I . The effect of the dose of human chorionic gonadotropin and the type of gonadotropin stimulation on oocyte recovery rates in an in vitro fertilization program. Fertil Steril. 1987; 48(6):958-63. DOI: 10.1016/s0015-0282(16)59591-0. View

Qin N, Chen Q, Hong Q, Cai R, Gao H, Wang Y . Flexibility in starting ovarian stimulation at different phases of the menstrual cycle for treatment of infertile women with the use of in vitro fertilization or intracytoplasmic sperm injection. Fertil Steril. 2016; 106(2):334-341.e1. DOI: 10.1016/j.fertnstert.2016.04.006. View

Zhang J, Mao X, Wang Y, Chen Q, Lu X, Hong Q . Neonatal outcomes and congenital malformations in children born after human menopausal gonadotropin and medroxyprogesterone acetate treatment cycles. Arch Gynecol Obstet. 2017; 296(6):1207-1217. DOI: 10.1007/s00404-017-4537-z. View

10.

Cummins J, Breen T, Harrison K, Shaw J, Wilson L, Hennessey J . A formula for scoring human embryo growth rates in in vitro fertilization: its value in predicting pregnancy and in comparison with visual estimates of embryo quality. J In Vitro Fert Embryo Transf. 1986; 3(5):284-95. DOI: 10.1007/BF01133388. View

11.

Kuang Y, Chen Q, Fu Y, Wang Y, Hong Q, Lyu Q . Medroxyprogesterone acetate is an effective oral alternative for preventing premature luteinizing hormone surges in women undergoing controlled ovarian hyperstimulation for in vitro fertilization. Fertil Steril. 2015; 104(1):62-70.e3. DOI: 10.1016/j.fertnstert.2015.03.022. View

12.

Henkel R, Schill W . Sperm preparation for ART. Reprod Biol Endocrinol. 2003; 1:108. PMC: 293422. DOI: 10.1186/1477-7827-1-108. View

13.

Mathur R, Akande A, Keay S, Hunt L, Jenkins J . Distinction between early and late ovarian hyperstimulation syndrome. Fertil Steril. 2000; 73(5):901-7. DOI: 10.1016/s0015-0282(00)00492-1. View

14.

Wang Y, Chen Q, Wang N, Chen H, Lyu Q, Kuang Y . Controlled Ovarian Stimulation Using Medroxyprogesterone Acetate and hMG in Patients With Polycystic Ovary Syndrome Treated for IVF: A Double-Blind Randomized Crossover Clinical Trial. Medicine (Baltimore). 2016; 95(9):e2939. PMC: 4782886. DOI: 10.1097/MD.0000000000002939. View

15.

Lu X, Hong Q, Sun L, Chen Q, Fu Y, Ai A . Dual trigger for final oocyte maturation improves the oocyte retrieval rate of suboptimal responders to gonadotropin-releasing hormone agonist. Fertil Steril. 2016; 106(6):1356-1362. DOI: 10.1016/j.fertnstert.2016.07.1068. View

16.

Zhu X, Ye H, Fu Y . The Utrogestan and hMG protocol in patients with polycystic ovarian syndrome undergoing controlled ovarian hyperstimulation during IVF/ICSI treatments. Medicine (Baltimore). 2016; 95(28):e4193. PMC: 4956813. DOI: 10.1097/MD.0000000000004193. View

17.

Oyesanya O, Teo S, Quah E, Abdurazak N, Lee F, Cheng W . Pituitary down-regulation prior to in-vitro fertilization and embryo transfer: a comparison between a single dose of Zoladex depot and multiple daily doses of Suprefact. Hum Reprod. 1995; 10(5):1042-4. DOI: 10.1093/oxfordjournals.humrep.a136090. View

18.

Dada T, Salha O, Baillie H, Sharma V . A comparison of three gonadotrophin-releasing hormone analogues in an in-vitro fertilization programme: a prospective randomized study. Hum Reprod. 1999; 14(2):288-93. DOI: 10.1093/humrep/14.2.288. View