Progestin prime ovarian stimulation provides comparable outcomes to GnRH antagonist in donor cycles with vitrified oocytes.

OBJECTIVE

To compare the effectiveness and safety of medroxyprogesterone acetate (MPA) and gonadotropin-releasing hormone antagonist (GnRHant) protocols in vitrified donor oocyte cycles and expand the current evidence on their clinical outcomes.

DESIGN

Retrospective cohort study.

SUBJECTS: This study included 14,981 recipients who received vitrified oocytes coming from 3,599 donors stimulated with MPA and 4,998 donors stimulated with GnRHant.

EXPOSURE: Pituitary suppression during ovarian stimulation with either MPA or GnRHant protocols.

MAIN OUTCOME MEASURES: Clinical metrics included implantation, clinical pregnancy rate, ongoing pregnancy rate and cumulative live birth rate. Nonclinical metrics included artificial intelligence (AI)-based oocyte and embryo quality scores.

RESULTS

The MPA group demonstrated significantly higher oocyte survival rates postwarming (90.17% vs. 88.41%) and blastocyst formation rates (57.58% vs. 53.99%) compared with the GnRHant group. Artificial intelligence-based evaluations revealed no significant differences in oocyte (5.9 ± 2.8 vs. 6.0 ± 2.9) or embryo (5.0 ± 2.6 vs. 5.1 ± 2.7) scores between the 2 groups. Clinical outcomes, including implantation rate (57.68% vs. 55.82%), clinical pregnancy rate (58.17% vs. 58.14%), ongoing pregnancy rate (49.40% vs. 48.15%) and cumulative live birth rate (65.60% vs. 65.50%), were comparable between MPA and GnRHant protocols. The paired analysis of donors stimulated with both protocols supported these findings, showing no significant differences in clinical outcomes. Finally, the Generalized Estimating Equations (GEEs) model identified significant predictors of live birth, including recipient age, recipient body mass index (BMI), number of metaphase II (MII) oocytes, embryo quality, and the number of warmed MII oocytes, whereas the type of pituitary suppression protocol (MPA vs. GnRHant) did not significantly impact live birth rates (odds ratio: 1.09 [95% confidence interval: 0.97-1.23]).

CONCLUSION

Medroxyprogesterone acetate and GnRHant protocols yielded comparable clinical outcomes in vitrified donor oocyte cycles. Artificial intelligence-based assessments showed consistency with clinical outcomes, detecting no significant differences in oocyte or embryo quality between protocols. These results support the use of MPA as a cost-effective, patient-friendly alternative in donor oocyte vitrification cycles, providing robust evidence for its clinical application.