Comparison of the pregnancy outcomes of progestin-primed vs. antagonist ovarian stimulation in patients with poor ovarian response: a retrospective study

Abstract

Objectives

Progestin-primed ovarian stimulation (PPOS) is an efficient controlled ovarian stimulation (COS) method. The study explored the pregnancy outcomes between PPOS and antagonist ovarian stimulation protocol (GnRH-ant) in infertile patients with poor ovarian response (POR).

Methods

This retrospective study included patients with POR who underwent COS at the Reproductive Medical Center of Shanxi Maternal and Child Health Hospital from January 2021 to April 2022. The cycles were grouped as the GnRH-ant group and the PPOS group. The primary outcome was the clinical pregnancy rate; the secondary outcomes included the biochemical pregnancy abortion rate and live birth rate.

Results

Frozen embryo transfer was used in all cycles in this study. The cycles were divided into the GnRH-ant (n = 236 cycles) and PPOS (n = 273 cycles) groups. Age, BMI, type of infertility, infertility duration, FSH, LH, PRL, E2, T, P, and the number of cycles in the hospital were similar between the two groups (all p > 0.05). No statistically significant differences were observed in the clinical pregnancy rate (primary outcome, 32.71% vs. 43.90%, p = 0.082), total Gn dose, total Gn days, ART mode (IVF or ICSI), AFC, MII follicles, 2PN embryos, fertility, cycle cancelation rate, biochemical pregnancy rate, abortion rate, or live birth rate between the two groups (all p > 0.05). The PPOS group exhibited a higher rate of high-quality embryos than the GnRH-ant group (50.12% vs. 42.90%, p = 0.045).

Conclusions

The PPOS protocol was comparable to the GnRH-ant protocol regarding induction parameters and cycle cancelation, biochemical pregnancy, clinical pregnancy, and abortion rates but might be associated with a higher proportion of high-quality embryos.

Keywords:

• High progesterone ovarian stimulation
• low ovarian response
• pregnancy outcome

Acknowledgments

Thanks to the Reproductive Medicine Center of Shanxi Maternal and Child Health Hospital for providing the data.

Availability of data and material

All data generated or analyzed during this study are included in this published article.

Ethical statement

The study was approved by the Medical Ethics Committee of Shanxi Maternal and Child Health Hospital (IRB-KY-2021-001). The informed consent of the patients was waived due to the retrospective nature of this study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the Shanxi Reproductive and Genetic Research Technology cultivation team under Grant (number: 2020TD19). The funder was not involved in the study design, collection, analysis, interpretation of data, writing the paper, or decision to submit it for publication.

Notes on contributors

Zuoping Shi

Zuoping Shi: Protocol/project development. Wenhui Zhao: Data collection or management. Xueqing Wu: Data analysis. Xingyu Bi: Manuscript writing/editing.

Wenhui Zhao

Zuoping Shi: Protocol/project development. Wenhui Zhao: Data collection or management. Xueqing Wu: Data analysis. Xingyu Bi: Manuscript writing/editing.

Xueqing Wu

Zuoping Shi: Protocol/project development. Wenhui Zhao: Data collection or management. Xueqing Wu: Data analysis. Xingyu Bi: Manuscript writing/editing.

Xingyu Bi

Zuoping Shi: Protocol/project development. Wenhui Zhao: Data collection or management. Xueqing Wu: Data analysis. Xingyu Bi: Manuscript writing/editing.