Application of progestin-primed ovarian stimulation protocol in patients with repeated in vitro fertilization/intracytoplasmic sperm injection-embryo transfer failure undregoing conventional ovarian stimulations

Abstract

Objective To explore the application of progestin-primed ovarian stimulation protocol in patients with repeated in vitro fertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET) failure undregoing conventional controlled ovarian hyperstimulation (COH). Methods The clinical data of 76 patients from January 2017 to December 2018 in Reproductive Center of the First Affiliated Hospital of Xiamen University with normal ovarian reserve who failed to get pregnancy with long protocol and gonadotropin-releasing hormone (GnRH) antagonist protocol, adopting long protocol or GnRH antagonist protocol again or administered with progestin-primed ovarian stimulation (PPOS) protocol followed by frozen-thawed embryo transfer (FET), were analyzed retrospectively. They were divided into two groups: conventional COH protocol group (group A, n=46), PPOS group (group B, n=30) according to different protocols. The clinical indicators, laboratory indicators and clinical pregnancy outcomes were compared between the two groups. Results The general conditions of patients in groups A and B were comparable. The normal fertilization rate (78.3%), available embryo rate (69.5%) and cumulative pregnancy rate (60.0%) in group B were higher than those in group A (70.3%, P=0.031; 57.9%, P=0.017; 34.8%, P=0.031). The difference was statistically significant. The high-quality embryo rate (52.4%) in group B was slightly higher than that in group A (48.0%) with no statistical significance (P=0.061). There were no significant differences between the two groups in the total amount of gonadotropin (Gn), the duration, estradiol level on human chorionic gonadotropin (hCG) injection day, amount and rate of MII oocytes, the number of two pronucleus (2PN) embryos, the cleavage rate, the implantation rate, the clinical pregnancy rate, and the early abortion rate (P>0.05). Conclusion For the patients with normal ovarian reserve function who failed to get pregnancy repeatedly with conventional COH protocols, PPOS protocol can improve the normal fertilization rate, the available embryo rate and the cumulative pregnancy rate, and may increase the high-quality embryo rate and eventually improve clinical pregnancy outcome. PPOS protocol provides a new way for these patients to choose COH protocol thirdly. Key words: Progestin-primed ovarian stimulation; Controlled ovarian hyperstimulation; Ovary reserve; Fertilization in vitro; Intracytoplasmic sperm injection; Repeated failure