Abstract
BackgroundMany studies have demonstrated the positive clinical value of progestin-primed ovarian stimulation (PPOS) in patients with polycystic ovary syndrome (PCOS) who underwent assisted reproductive technology. However, the underlying factors contributing to this phenomenon remain unclear. We conducted a retrospective observational study to compare the clinical outcomes of women with PCOS who underwent PPOS or the short protocol to identify possible factors that influence the outcome.MethodsThis study included 304 patients who underwent PPOS and 152 patients who underwent short protocol from April 2014 to July 2019 after propensity-score matching. Human menopausal gonadotropin (hMG) dose, hormone profile, embryo development, and clinical outcomes of frozen-thawed embryo transfer (FET) cycles were compared. The primary outcome measure was the implantation rate. Logistic regression was performed to identify contributing factors, and receiver operating characteristic curve analysis was used to calculate the cutoff of luteinizing hormone (LH) difference ratio in clinical outcomes.ResultsCompared with the short protocol, PPOS resulted in a higher implantation rate (43.4% vs. 31.9%, P < 0.05), clinical pregnancy rate (61.8% vs. 47.4%, P < 0.05), and live birth rate (48.4% vs. 36.8%, P < 0.05). Similar fertilization, cleavage, and valid embryo rate per oocyte retrieved between groups were observed. The LH difference ratio was positively associated with implantation rate [P = 0.027, odds ratio (OR) = 1.861, 95% CI: 1.074–3.226]. The relationship between the LH difference ratio with clinical outcomes was confirmed by receiver operating characteristic curve analysis and comparisons among patients grouped by the LH difference ratio.ConclusionThe implantation rate was associated with the LH difference ratio during ovary stimulation in patients with PCOS. Our results provide the explanation why PPOS shows the positive clinical outcomes for patients with PCOS.
Highlights
Polycystic ovary syndrome (PCOS) is the most common endocrinopathy in women of reproductive age, and more than 80% of patients with anovulatory infertility suffer from PCOS (Thessaloniki EA-SPCWG, 2008; Balen et al, 2016)
A total of 1,756 female patients with PCOS who underwent In vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) were screened from our database, such as 1,544 treated with Progestin-primed ovarian stimulation (PPOS) and 212 treated with the short protocol (Supplementary Table 1)
No significant differences were found between the PPOS and short protocol groups in post-matching analysis with regard to characteristics of patients and the first FET cycle, such as age, body mass index (BMI), duration of infertility, TABLE 2 | Factors influencing implantation success in the first frozen-thawed embryo transfer cycle by logistic regression analysis
Summary
Polycystic ovary syndrome (PCOS) is the most common endocrinopathy in women of reproductive age, and more than 80% of patients with anovulatory infertility suffer from PCOS (Thessaloniki EA-SPCWG, 2008; Balen et al, 2016). Previous randomized and retrospective studies reported optimal clinical outcomes, such as higher rates of fertilization, pregnancy, and implantation, in patients with PCOS treated with PPOS (Wang et al, 2016; Zhu et al, 2016). Many studies have demonstrated the positive clinical value of progestinprimed ovarian stimulation (PPOS) in patients with polycystic ovary syndrome (PCOS) who underwent assisted reproductive technology. We conducted a retrospective observational study to compare the clinical outcomes of women with PCOS who underwent PPOS or the short protocol to identify possible factors that influence the outcome
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