Hong Chen

and 8 more

Background There is scarcity of information about the cumulative live birth rates(CLBRs) and time to live birth(TTLB) between progestin primed ovarian stimulation protocol(PPOS) and long GnRH agonist protocol. Objective To compare CLBRs and TTLB in women with normal ovarian reserve following PPOS with long GnRH agonist protocol. Methods A total of 995 women who underwent IVF using either PPOS (n=509) or GnRH antagonist (n=486) ovarian stimulation at the discretion of the attending physicians. The primary outcome measure was the CLBRs within 18 months from the day of ovarian stimulation. Results Both groups had almost comparable demographic and cycle stimulation characteristics except for duration of infertility which was shorter in the PPOS group. CLBRs after one complete IVF cycle including fresh and subsequent FET cycles within 18 months follow up were significantly lower in the PPOS group compared that in the long agonist group 206/509 (40.5%) and 307/486 (63.2%), respectively (odds ratio (OR): 0.641; 95% CI: 0.565-0.726). The average TTLB was significantly shorter in the long agonist group compared to the PPOS group (P < 0.01). In Kaplan-Meier analysis, the cumulative incidence of ongoing pregnancy leading to LB was significantly higher in the long agonist compared in the PPOS group (P < 0.001). Cox regression analysis revealed stimulation protocol adopted was strongly associated with the CLBRs after adjusting other confounding factors (OR =1.917 (1.152-3.190), P=0.012). Conclusion PPOS offers no advantage over conventional protocol in women with a normal ovarian reserve undergoing IVF. Keywords: PPOS, long GnRH agonist protocol, IVF, CLBRs, TTLB

Hong Chen

and 7 more

Objective To compare the pregnancy outcomes of first frozen-thawed embryo transfer in women undergoing IVF using progestin primed ovarian stimulation (PPOS) versus GnRH antagonist protocol. Design Retrospective cohort study. Setting Tertiary-care academic medical center. Population/Sample 382 infertile women with normal ovarian reserve underwent IVF. Methods Women were allocated to PPOS group (n=184) or GnRH antagonist group (n=198) at the discretion of the attending physicians. Main outcome measures The primary outcome was the ongoing pregnancy rate of first FET cycles. Results Both groups had almost comparable demographic and cycle stimulation characteristics. The ongoing pregnancy (34.0 % (49/114) vs 42.3% (52/123), P=0.166, RR=0.81(0.59-1.09)), clinical pregnancy (38.2% (55/144) vs 44.7% (55/123), P=0.281, RR=0.85 (0.64-1.14)) and implantation (29.5% (75/254) vs 31.6% (68/215), P=0.623, RR=0.93 (0.71-1.22)) rates were comparable between the PPOS group and the antagonist group respectively. In order to control the difference in demographic and index stimulated IVF cycle characteristics, a multivariate logistic regression revealed that only the stimulation protocol and number of embryos replaced were significant factors in predicting the ongoing pregnancy. Conclusion The use of medroxyprogesterone during ovarian stimulation is effective in blocking the LH surge, and does not affect the number of oocytes collected in the woman with normal ovarian reserve. However,developmental potential of embryos originating from this regimen seems to be affected compared to those from the antagonist group.