European journal of obstetrics, gynecology, and reproductive biology · 2025
A retrospective comparison of live birth rate in freeze-all cycles between progestin-primed ovarian stimulation with dydrogesterone and GnRH antagonist protocols.
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Le Tien Khac, Pham Toan Duong, Le Xuyen Thi-Ha, Ho Nguyen-Tuong, Le Ho Long, Ho Tuong Manh, Vuong Lan Ngoc
Аннотация
RESEARCH QUESTION: Does progestin-primed ovarian stimulation (PPOS) using dydrogesterone yield a live birth rate comparable with the gonadotrophin-releasing hormone (GnRH) antagonist protocol in in-vitro fertilization (IVF) freeze-all cycles?
DESIGN: This retrospective cohort study, conducted at a tertiary hospital from June 2022 to January 2024, included 1045 women aged 18-40 years undergoing IVF/intracytoplasmic sperm injection with freeze-all indications. Participants were assigned to receive PPOS-dydrogesterone (n = 482) or GnRH antagonist (n = 563), followed by frozen embryo transfer (FET). The primary outcome was the live birth rate after the first FET cycle.
RESULTS: The live birth rate after the first FET cycle were comparable between the PPOS-dydrogesterone (35.1 %) and GnRH antagonist (40.3 %) groups (p = 0.092), showing no significant difference. The PPOS-dydrogesterone group experienced a longer stimulation period [mean ± standard deviation (SD) 8.4 ± 2.0 vs 8.0 ± 2.0 days; p = 0.002] and a higher gonadotrophin dosage (mean ± SD 2622.2 ± 818.8 vs 2413.4 ± 663.4 IU; p < 0.001) than the GnRH antagonist group, but produced more blastocysts (mean ± SD 6.3 ± 3.9 vs 5.6 ± 3.5; p = 0.013). Multivariate analysis showed that age [adjusted odds ratio (aOR) 0.96, 95 % confidence interval (CI) 0.93-0.99; p = 0.006] and anti-Müllerian hormone concentration (aOR 1.05, 95 % CI 1.01-1.10; p = 0.011) were key predictors of live birth, overshadowing protocol effects (aOR 1.27, 95 % CI 0.98-1.67; p = 0.076).
CONCLUSION: The PPOS-dydrogesterone protocol has a similar live birth rate to the GnRH antagonist protocol in IVF freeze-all cycles, with added benefits in blastocyst yield despite higher stimulation demands. Patient factors, rather than protocol choice, primarily drive outcomes, positioning the PPOS-dydrogesterone protocol as an effective alternative to the GnRH antagonist protocol.
DESIGN: This retrospective cohort study, conducted at a tertiary hospital from June 2022 to January 2024, included 1045 women aged 18-40 years undergoing IVF/intracytoplasmic sperm injection with freeze-all indications. Participants were assigned to receive PPOS-dydrogesterone (n = 482) or GnRH antagonist (n = 563), followed by frozen embryo transfer (FET). The primary outcome was the live birth rate after the first FET cycle.
RESULTS: The live birth rate after the first FET cycle were comparable between the PPOS-dydrogesterone (35.1 %) and GnRH antagonist (40.3 %) groups (p = 0.092), showing no significant difference. The PPOS-dydrogesterone group experienced a longer stimulation period [mean ± standard deviation (SD) 8.4 ± 2.0 vs 8.0 ± 2.0 days; p = 0.002] and a higher gonadotrophin dosage (mean ± SD 2622.2 ± 818.8 vs 2413.4 ± 663.4 IU; p < 0.001) than the GnRH antagonist group, but produced more blastocysts (mean ± SD 6.3 ± 3.9 vs 5.6 ± 3.5; p = 0.013). Multivariate analysis showed that age [adjusted odds ratio (aOR) 0.96, 95 % confidence interval (CI) 0.93-0.99; p = 0.006] and anti-Müllerian hormone concentration (aOR 1.05, 95 % CI 1.01-1.10; p = 0.011) were key predictors of live birth, overshadowing protocol effects (aOR 1.27, 95 % CI 0.98-1.67; p = 0.076).
CONCLUSION: The PPOS-dydrogesterone protocol has a similar live birth rate to the GnRH antagonist protocol in IVF freeze-all cycles, with added benefits in blastocyst yield despite higher stimulation demands. Patient factors, rather than protocol choice, primarily drive outcomes, positioning the PPOS-dydrogesterone protocol as an effective alternative to the GnRH antagonist protocol.