P-690 Medroxyprogesterone acetate versus cetrotide in oocyte donation: Non-randomized clinical trial
Authors: Rivera Montes A  M , González Trejo C , Carrillo Vidrio H  J , Hernández Ruiz C  O , Roque Huamani J  H 
Published: July 2024

Abstract

Study question
Is oral medroxiprogesterone acetate non-inferior compared to cetrotide with respect to the number of mature oocytes retrieved at ovum pick-up in oocyte donation (OD) cycles?

Summary answer
MPA is comparable to cetrotide in terms of number of mature oocytes (MII) retrieved at ovum pick-up (OPU) in oocyte donation cycles.

What is known already
Progesterone primed ovarian stimulation (PPOS) uses progestin as an alternative to a GnRH analog for suppressing a premature LH surge during the follicular phase. Published reports indicate that both the number of MII retrieved and pregnancy rates from these oocytes are comparable to protocols using GnRH analogues. Among new stimulation approaches to OD, the use of MPA taken orally has been used successfully, avoiding the need for injecting a GnRH analogue, allowing for more comfortable and cost-effective ovarian stimulation. Another advantage is that vitrification is avoided because the woman undergoing stimulation is not the recipient of the transfer.

Study design, size, duration
A prospective, non-randomized clinical trial including 23 oocyte donors was performed between February 2020 and February 2021 to evaluate the non-inferiority of MPA (10 mg/day) versus cetrotide (0.25 mg/day) from day 6, in ovarian stimulation cycles triggered with triptorelin acetate. Trigger criterion was ≥6 follicles with a diameter &gt;18 mm

Participants/materials, setting, methods
All oocyte donors who came for the first time were included. Two OS were performed, the first with a fixed antagonist protocol (hMG and cetrotide), the second PPOS (hMG and MPA). Transvaginal ultrasound was performed, and serum estradiol levels were recorded during monitoring. The main outcome was the number of MII retrieved at OPU. Secondary outcomes were embryological laboratory outcomes and reproductive outcomes in recipients.

Main results and the role of chance
Basic characteristics, such as age and BMI were comparable, less than 12 months between one donation and another. Duration of stimulation was similar in both OS (10 days), as well as the total gonadotropin dose up to trigger (2544 IU in MPA and 2630 IU in cetrotide). The number of MII retrieved was no different: 11.9 (SD 2.9) with MPA and 10.9 (SD 3.8) in cetrotide (p = 0.5). Recipients and embryo transfer (ET) characteristics were also similar between groups. The mean number of MII assigned to each recipient was 9.2 (SD 2.8) in MPA and 8.2 (SD 3.09) in cetrotide (P = 0.58). MII were fertilized with partner sperm in 93% cycles overall and fertilization rate was 70% in MPA versus 69% in cetrotide (P = 0.61). The number of D5 blastocysts was 4 (SD 2.9) in MPA and 3.56 (SD 2.6) in cetrotide. Overall, there was 99% of double ET and 1% of single ET, with 93.2% of ETs were performed in D5. No significant difference was found in the clinical pregnancy rate 55.3% versus 54.5% (P = 0.785); ongoing pregnancy rate 55.3% versus 50.9% (P = 0.419) and live birth rate 51.1%versus 45.5%, (P = 0.255).

Limitations, reasons for caution
The patients and physician were not blinded to the study. Further, a large proportion of patients were still pregnant at the end of the clinical trial, therefore live birth rates were not observed in the follow-up period.

Wider implications of the findings
Ovarian stimulation using MPA for LH surge prevention produces a comparable number of MII oocytes, fertilization rates and live birth rate compared to cetrotide in oocyte donation cycles with the advantage of being a more comfortable and cost-effective ovarian stimulation.

Trial registration number
Not applicable