Progestin-primed ovarian stimulation versus gonadotropin-releasing hormone antagonist protocol in intracytoplasmic sperm injection cycles in patients with different ovarian reserve: a retrospective cohort study

ABSTRACT
Objective. To compare the intracytoplasmic sperm injection (ICSI) cycle out- comes in PPOS vs conventional gonadotropin-releasing hormone (GnRh) antagonist protocol.
Patients and Methods. In this retrospective cohort study, 200 patients who were administrated gonadotropins for ovarian stimulation from the second or the third day of menstruation cycle were included in this study. When the follicular diameter reached 13-14 mm, GnRH antagonist was started in the group A, while in the group B,10 mg norethisterone acetate was taken daily orally. The retrieved oocytes were fertilized in vitro by intracytoplas- mic sperm. Both groups underwent freeze-all and delayed embryo transfer. The primary outcome is the clinical pregnancy rate. The secondary outcomes included the duration, dosage and form of ovarian stimulation, the number and quality of oocytes retrieved which means mature and well-functioning oocytes, the number of MII oocytes, and the number and quality of embryos.
Results. A total of 200 women were recruited, with 100 in the PPOS group and 100 in the GnRH antagonist group. The PPOS group had lower clinical pregnancy rate compared with the GnRH antagonist protocol group. PPOS group showed also, lower number of oocytes retrieved, lower number of M II oocytes however, they had better quality of oocytes and lower rate of class A embryos when compared with the GnRH antagonist protocol group.
Conclusions. Compared with PPOS, GnRH antagonist protocol had higher clinical pregnancy rate. PPOS may be suitable for oocyte or embryo cryo- preservation, but should not totally replace GnRH antagonist for patients undergoing in vitro fertilization (IVF).