Progestin-primed ovarian stimulation for oocyte cryopreservation in patients with nonmedical indications: a case–control study

Abstract

Abstract Background The PPOS (Progestin Primed Ovarian Stimulation) protocol has been evaluated and has proved its effectiveness in preventing the LH (luteinizing hormone) surge. This protocol is often used for cryopreservation for social reasons because it is simpler and more cost-effective. The objective of our study was to evaluate the efficacy and the convenience of the PPOS protocol in the context of oocyte cryopreservation for social reasons. Methods In this bicentric matched case‒control study, all PPOS cycles performed for nonmedical reasons between January 2021 and June 2023 were included. Each PPOS cycle was matched with 2 control cycles performed with the antagonist protocol on the basis of the antral follicle count (+/- 5), BMI (+/- 2 kg/cm2) and starting gonadotropin dose (+/- 75 UI). The primary endpoint was the number of mature oocytes. The secondary endpoints were other parameters and outcomes of COS. We evaluated the convenience of PPOS by analysing the frequency of monitoring sessions. Univariate analysis was performed via univariate conditional logistic regression. Multivariate analysis was performed via conditional multivariate logistic regression for significant parameters in the univariate analysis (p < 0.2). Results The patient characteristics were comparable, except the median age, which was lower in the antagonist group (35.5 vs. 34.6 years, p < 0.001). Multivariate analysis revealed no statistically significant difference in the number of metaphase II (MII) oocytes between the groups (p = 0.91) or in the total number of COCs retrieved (0.94). There was no statistically significant difference between the groups in terms of the maturation rate or the OSI (p = 0.38 and p = 0.16). The number of monitoring sessions was significantly lower in the PPOS protocol group (p < 0.001). Conclusion The response to ovarian stimulation with the PPOS protocol for oocyte cryopreservation in patients with nonmedical indications does not differ statistically from that with the antagonist protocol in terms of the number of MII oocytes. This protocol offers the advantages of a more patient-friendly approach through oral administration, a significantly lower number of monitoring sessions with the same efficacy as the antagonist protocol and could be offered as a first line treatment. Clinical trial number NA. Trial registration date NA.

Keywords

• Social freezing
• Fertility preservation
• Dydrogesterone
• Progestin-stimulated ovarian stimulation
• Ovarian stimulation index