P-607 Reproductive outcomes of oocyte donors using subdermal etonogestrel implants and levonorgestrel intrauterine devices
Authors: Blazquez A , Miguel-Escalada I , Forcada C , Correa-Mañas N , Popovic M , Mataró D , Rodriguez A 
Published: July 2024

Abstract

Study question
Does the use of progesterone contraceptive devices during controlled ovarian stimulation (COS) affect ovarian response in oocyte donation cycles?

Summary answer
Progesterone contraceptive devices during COS did not impact ovarian response, measured by oocyte retrieval and maturity rates, in oocyte donation cycles.

What is known already
Subdermal etonogestrel implants and levonorgestrel intrauterine devices (L-DIU) are widely used contraceptives amongst oocyte donors. While the safe and effective use of L-DIU during COS has been documented, the impact of subdermal etonogestrel implants on ovarian response is less understood. Given their distinct mechanisms of action and varying local and systemic pharmacodynamics, a comprehensive understanding of the impact of these contraceptives on ovarian response during COS will be crucial for guiding informed clinical practice.

Study design, size, duration
In this retrospective cohort study, we analyzed 3,452 heterologous ICSI cycles from 1,975 oocyte donors (18-35 years), performed between March 2021 and September 2023, across two centers. We identified 40 COS in donors using contraceptive devices, either a subdermal etonogestrel implant (n = 18) or L-DIU, (n = 22). These were matched with 80 COS without a device. We primarily compared ovarian response amongst the two groups. Secondary outcomes included biochemical pregnancy, clinical pregnancy and live birth rates.

Participants/materials, setting, methods
We applied a propensity matching score model (PsmPy package, Python), trained on 3,388 oocyte donation cycles, for matching donors with and without contraceptive devices. Matching was based on age, BMI, anti-müllerian hormone (AMH) and antral follicle count (AFC), maintaining a 1:2 ratio. Ovarian response outcomes (oocyte retrieval and maturation rates) were analyzed using Student’s t-tests, while and clinical outcomes were evaluated using Fisher’s exact test. P-values &lt;0.05 were considered significant.

Main results and the role of chance
Mean age was 26.22, BMI 24.7, AMH 2.63 ng/ml and AFC 18.77. We evaluated a total of 120 COS, leading to 176 heterologous ICSI cycles. The oocyte retrieval rate (total number of cumulus-oocyte-complexes (COCs) per total number of follicles &gt; 14mm at final follicular scan), averaged 109.64%. We observed no differences in the number of COCs retrieved from donors with and without contraceptive devices (17.5 ±7.6 and 18.5 ± 9.6, respectively). Similarly, oocyte maturation rates (total number of MII oocytes per total number of COCs), were comparable amongst the two groups (78.6% overall, 77.6% with contraception device and 79.1% without contraception device, p &gt; 0.05). The presence of the device did not affect biochemical pregnancy (69.7% with contraceptive device, 61.1% without contraceptive device, p &gt; 0.05), clinical pregnancy (54.6% with contraceptive device, 52.9% with contraceptive device, p &gt; 0.05) and ongoing pregnancy (36.4% with contraceptive device, 35.3% without contraceptive device). These results were consistent regardless of the type of device used.

Limitations, reasons for caution
The main limitation is the retrospective nature of the study, potentially influencing causal inferences, and that both devices were analyzed as one same group. The small subset of COS with contraceptive devices may impact statistical power. Perinatal outcomes were not analyzed.

Wider implications of the findings
This research provides clinicians with reassurance that the use of progesterone contraceptive devices during COS does not adversely affect clinical outcomes. These findings offer valuable insights for patient counseling, affirming the safety of contraceptive methods and encouraging further research for a more comprehensive understanding in diverse populations and clinical settings.

Trial registration number
not applicable