Progestin primed ovarian stimulation yields comparable outcomes to the GnRH antagonist protocol for controlled ovarian hyperstimulation

Abstract

To prevent the occurrence of a luteinizing hormone surge during assisted reproductive technology cycles, clinicians commonly utilize gonadotropin-releasing hormone (GnRH) analogues or progestin. However, there is a paucity of data directly comparing the reliability and efficacy of these strategies. This retrospective study compares ovarian stimulation outcomes in intracytoplasmic sperm injection (ICSI) cycles using either a progestin-primed ovarian stimulation (PPOS) protocol or a GnRH antagonist protocol for controlled ovarian hyperstimulation, conducted between January 2022 and November 2023. A total of 385 patients were analyzed, with 150 receiving the PPOS protocol and 235 receiving the GnRH antagonist protocol. There were no significant differences in oocyte yield, embryo quality, fertilization rates, or pregnancy outcomes between the two groups. Multiple regression analysis revealed that the type of stimulation protocol was not associated with live birth rates (LBR). However, longer infertility duration (p = 0.011) and diminished ovarian reserve (p < 0.001) were linked to lower LBR. Conversely, a higher number of good-quality embryos (p = 0.003), increased blastocyst formation rates (p = 0.003), and two-embryo transfers (p = 0.003) were associated with improved LBR. These findings suggest that the PPOS protocol is an effective approach for ovarian stimulation in ICSI cycles, demonstrating comparable outcomes to GnRH antagonists across multiple outcome measures.