P-700 Oral progestins are a good alternative to traditional antagonists in freeze all IVF cycles yielding comparable mature oocyte rate and viable embryo number
Authors: Amrahova N , Haciyeva S , Garabaghli J , Garayeva S , Hagverdiyev E , Tulumbaci O 
Published: June 2022

Abstract

Study question
May oral progestins be a good alternative to traditional antagonists in freeze all cycles and yield comparable number of mature oocytes and viable embryos?

Summary answer
Oral progestins are an effective alternative to antagonists in preventing premature ovulation in freeze all cycles, are more patient friendly and have a lower cost.

What is known already
Progestine-primed ovarian stimulation (PPOS) protocols are new protocols available for the last 5-6 years that proved to be effective in preventing premature LH surge. A recent meta-analysis by Shaogen Guan et al. including 9 studies with 1885 cycles showed that PPOS is an effective ovarian stimulation protocol and may be an alternative to antagonist in planned freeze all in vitro fertilization (IVF) cycles.

Study design, size, duration
Our study is retrospective cross sectional self-controlled study. We compared 2 groups of patients with 150 patients in each group undergoing IVF treatment for the period from September 2019 to November 2021 in our centre.

Participants/materials, setting, methods
We used oral dydrogesterone 20 mg a day from the first day of stimulation in progestine group and started cetrorelix 0.25 mg after having 2 follicles &gt; 12 mm in antagonist group. "Freeze all" strategy was applied in progestine group. In antagonist group patients underwent either "freeze all" or fresh transfer. Patients aged 21-34, with antral follicle count &gt; 10 were included. Patients with endometriomas and poor oocyte quality on the previous cycles were excluded.

Main results and the role of chance
Mean age of patients in dydrogesterone group was 27,9 and in antagonist group - 27,3. We used recombinant follicle stimulating hormone (rFSH) in patients younger than 30 years of age and combined it with human menopausal gonadotropin (HMG) in patients older than 30. For final oocyte maturation decapeptyl was used in progesterone group and either decapeptyl or human chorionic gonadotropin in antagonist group.
Mean amount of rFSH used for one cycle in dydrogesterone group was 1726 IU and HMG 562,5 IU; in antagonist group 2013,7 and 665.6 IU respectively. There was no noticeable difference between total number of retrieved oocytes and in maturity rate. Mean number of retrieved oocytes was 18,3 in dydrogesterone group and 17,1 in antagonist group (p = 0.138). Mean number of mature oocytes were 13,4 (73,2%) and 13,1 (76,1%) in dydrogesterone and antagonist groups respectively (p = 0.131). We also didn't find significant difference in number of viable embryos on the day 3: 7,9 in dydrogesterone group and 8.3 in antagonist group (p = 0,321).
As a secondary outcome we looked at ongoing pregnancy rate and there was also no significant difference between two groups. This number was 37,5 % in PPOS group and 35,6 % in antagonist group (p = 0,335).

Limitations, reasons for caution
We didn't exclude patients with severe male factor which might influence our secondary outcome. Patients with polycystic ovarian syndrome (PCOS) were included in the study mainly in the dydrogesterone group, it is known that in these patients maturity problems may happen. Use of different trigger agents may put some limitations.

Wider implications of the findings
We showed in our study that PPOS protocols are not inferior to traditional antagonist protocol. These protocols are more patient-friendly because of less number of injections and probably less number of ultrasound folliculometry as well as lower cost. Tablets are easy to take and patient compliance is good.

Trial registration number
not applicable