Comparison of efficacy between progestin-primed ovarian simulation and gonadotropin-releasing hormone antagonist protocol in polycystic ovary syndrome patients

Abstract

Objective To compare the efficacy between the progestin primed ovarian stimulation (PPOS) protocol and gonadotropin-releasing hormone antagonist (GnRH-A) protocol in polycystic ovary syndrome (PCOS) patients who underwent in vitro fertilization (IVF). Methods A retrospective analysis was performed in a total of 159 patients with PCOS who performed IVF/intracytoplasmic sperm injection (ICSI) from September 2016 to February 2018 in Reproductive Center of Henan Province People’s Hospital. Among them, 87 patients were treated with PPOS protocol and 72 with GnRH-A protocol. The basic information, process of controlled ovarian hyperstimulation, and pregnancy outcome were compared between the two groups. Results There were no statistically significant differences in age, body mass index (BMI), basal sex hormone levels between the two groups (P>0.05). The number of previous failures in PPOS group was greater than that in GnRH-A group, and the difference was significant (P=0.006). Amount of gonadotropin (Gn) [(2 124.86±1 164.67) IU] and follicle stimulating hormone (FSH) [(11.56±3.35) IU/L], the number of dominant follicle (diameter≥14 mm) (8.86±5.29), estradiol level on the human chorionic gonadotropin (hCG) trigger day [(2 024.50±1 227.23) ng/L] in PPOS group were higher than those in GnRH-A group [(1 470.89±667.92) IU, (9.50±3.41) IU/L, 7.11±5.18, (1 529.44±1 300.84) ng/L], while the oocyte retrieval rate (74.69%) was lower than that in GnRH-A group (78.87%), the differences were statistically significant (P=0.035). Between the two groups, cycle cancellation rate, biochemical pregnancy rate, clinical pregnancy rate, early abortion rate and ectopic pregnancy rate had no significant differences (P>0.05). When first frozen embryo transfer (FET) after freezing all the fresh embryos were carried out. And the cumulative pregnancy rates after egg retrievals between the two groups had no statistical differences. Conclusion The application of PPOS protocol in PCOS patients can effectively inhibit the early LH peak, and can further reduce the risk of OHSS compared with GnRH-A protocol, can achieve similar clinical pregnancy outcomes. Key words: Polycystic ovary syndrome; Controlled ovarian hyperstimulation; Gonadotropin-releasing hormone antagonist protocol; Progestin primed ovarian stimulation; Antagonist protocol