O-255 Comparison of in vitro fertilization outcomes between progestin-primed and antagonist ovarian stimulation protocols

Abstract Study question How effective is the PPOS protocol with Dydrogesterone in luteinizing hormone suppression, and how does it impact IVF outcomes compared to the GnRH antagonist protocol? Summary answer The PPOS was effective in LH surge suppression, slightly improving oocyte retrieval, maturity, and embryo quality, with comparable pregnancy outcomes to the GnRH-ant protocol. What is known already Controlled ovarian stimulation (COS) is a crucial step in IVF, and premature LH surge is the leading cause of cycle cancellation during COS. Since 2014, GnRH-ant protocols have been favoured due to reduced duration, injections, costs, and OHSS risk compared to the GnRH agonist protocol. Introduced in 2015 by Kuang et al., PPOS utilizing oral progestins, has become a potential alternative due to convenience, more cost reduction, and comparable outcomes to GnRH-ant protocol. This study aims to evaluate PPOS’s effectiveness in LH suppression and IVF outcomes through a randomized clinical trial in Vietnamese’s general infertile population. Study design, size, duration This open-label randomized controlled trial was conducted at the Tam Anh General Hospital, between February 2023 and January 2024. A total of 220 women were enrolled in the study and randomly allocated into two groups: the intervention group (110 cases in the PPOS protocol) and the control group (110 cases in the GnRH-ant protocol). Participants/materials, setting, methods The clinical trial included infertile women aged 20-45 undergoing ICSI using either the GnRH-ant or PPOS protocol, excluding those with contraindications, specific medical conditions, abnormal uterine structure, or other modified cycles (e.g., random-start cycles). Data analysis employed generalized linear models and binomial regression to evaluate outcomes, adjusting for baseline and procedural factors. Results were presented through medians, percentiles, adjusted risk differences, and odds ratios to ensure accurate and reliable estimates. Main results and the role of chance The study highlights key findings that reflect the effectiveness of the PPOS and GnRH antagonist protocols in ovarian stimulation cycles for infertile women. First, the study population is representative of the broader infertile population and balanced between the two intervention arms, ensuring minimized selection bias. Second, the PPOS protocol showed a gradual decline in LH levels, aiding in managing premature surges. Compared to the GnRH antagonist protocol, the PPOS protocol demonstrated a slight yet significant increase in retrieved oocytes (1.87) and mature oocytes (4.1%). Additionally, PPOS showed better outcomes in embryo quality, particularly in achieving transferable embryos, with an average increase of 4.6%. Despite these advantages, the overall success rates in fertilization, embryo formation, and clinical pregnancy were comparable between the two protocols. Ultimately, both protocols showed equivalent success in embryo implantation and ongoing pregnancy outcomes post-transfer. Limitations, reasons for caution ART outcomes vary, with live birth rates (LBR) being the most desirable and focusing solely on ongoing pregnancy limits analysis. However, PPOS impacts are mainly in the early stages, so extending follow-up may be unnecessary. Moreover, assessing cumulative effects requires advanced methods to manage biases for a comprehensive understanding. Wider implications of the findings All infertile women indicated for IVF should be counselled on the option of adopting the PPOS protocol using DYG (30 mg/d) as an alternative to the GnRH-ant protocol. Counseling should highlight the advantages of the PPOS protocol, including its safety profile and expected efficacy including oocyte and embryo yield. Trial registration number Yes