#172 : The Comparison of Intra-Cytoplasmic Sperm Injection (ICSI) Treatment Outcome for Patient Stimulated with Progestine-Primed Ovarian Stimulation (PPOS) and Gonadotrophin-Releasing Hormone Agonist (GnRHa) Long Protocol

Abstract

Background and Aims: GnRHa long protocol is a traditional method with benefits such as synchronisation of follicular development, higher oocytes recovery, and improved endometrial thickness but it possesses higher fees with long injection timeline. However, PPOS is an ovarian stimulation protocol that can block the surge of luteinizing hormone (LH) through progesterone instead of the traditional method. This prospective randomized trial is to investigate whether PPOS can be as effective as GnRHa long protocol in ICSI treatment for patients. Method: A total of 55 patients with mean age 36.67 who underwent ICSI cycle in TMC Fertility Centre Ipoh, Malaysia from Jan 2015 to December 2022 was analysed between PPOS and GnRHa long protocol. The embryological and clinical outcomes were measured using statistical analysis T-test with a significant value at p<0.05. Patients above 42-years-old was excluded in this study. Results: Basic characteristics such as infertility duration, age, anti-mullerian hormone (AMH), antra-follicle count (AFC) and body mass index (BMI) were comparable in both groups. There was no significant difference found between PPOS and GnRHa long protocol in the number (mean± SD) oocytes retrieved [9.33±7.38 vs 8.55±7.44, p=0.352]; fertilized oocytes [5.79±4.92 vs 4.03±4.12, p=0.081]; number of blastocysts formed [4.35±2.82 vs 3.11±3.23, p=0.147] and utilized blastocysts [2.79±1.42 vs 2.35±2.66, p=0.300]. There was also no significant difference in clinical pregnancy rate (p=0.456) in both groups. No patient from either group experienced cycle cancellation due to the low number of oocytes expected. No ovarian hyperstimulation (OHSS) syndrome was reported from both groups as well. Conclusion: PPOS in combination with embryo cryopreservation as an ovarian stimulation regimen was as effective as GnRHa long protocol during controlled ovarian stimulation (COH) under different endocrinal mechanisms as it can achieve comparable embryological and clinical outcome. Hence, it can be an alternative treatment for infertile patients in ART in terms of cost and treatment timeline.