COMPARING BLASTOCYST EUPLOIDY RATES BETWEEN PROGESTIN-PRIMED AND GONADOTROPHIN-RELEASING HORMONE ANTAGONIST PROTOCOLS IN ANEUPLOIDY GENETIC TESTING: A RETROSPECTIVE ANALYSIS

Abstract

Objective

This study aims to compare the euploidy rate of blastocysts following the progestin-primed ovarian stimulation (PPOS) protocol and the gonadotropin-releasing hormone antagonist protocol in women undergoing preimplantation genetic testing for aneuploidy (PGT-A).

Materials & Methods

This is a retrospective study. The data of the total of 269 women undergoing PGT-A were analyzed. They were divided into two groups. 1) The antagonist group (n:153): an antagonist given once daily from day 6 of ovarian stimulation till the day of the ovulation trigger; and 2) The PPOS (n:116) group: medroxyprogesteron from the first or sixth day of ovarian stimulation till the day of ovulation trigger. The primary outcome is the euploidy rate of blastocysts.

Results

Basal characteristics were similar in the two groups; a substantial similarity of the main outcome measures in the two treatment groups has also been found. The mean ages (±Std) were 34,9 ±4,7 for group 1 and 33,8 ±3,8 for group 2, respectively (p=0,102). The means of antral follicle counts (±Std) were 15,6 ±11,3 for group 1 and 14,7 ±8,2 for group 2, respectively (p=0,732). The means of duration of infertility (±Std) were 4,3 ±3,7 for group 1 and 4,4 ±3,8 for group 2, respectively (p=0,962). The means of body mass index (±Std) were 25,1 ±4,6 for group 1 and 25,3 ±4,7 for group 2, respectively (p=0,654). The rates of formation of euploid blastocysts per oocytes were 55,8% for group 1 and 55% for group 2 respectively (p=0,931). Further subgroup analysis also showed there were not significant differences between below and above 35 years old patient data. The euploidy rates under 35 years old were 67,1% for group 1 and 58,6% for group 2 (p=0,153) and over 35 years old were 40,2% for group 1 and 58,6% for group 2 (p=0,469) respectively.

Conclusion

There are some studies showing there is no significant difference in rate of euploidy between PPOS and antagonist protocols.^1,2 But, there is a recent retrospective study showing that PPOS protocol could potentially reduce the euploidy rate in aging IVF patients when compared to the conventional GnRH-antagonist approach.³ However, in our study we found no significant difference in the rate of euploid embryo between the antagonist and the PPOS groups in general population and also at younger or older age groups. Therefore, our results encourage the use of PPOS protocol for candidates for preimplantation genetic testing. Since our study is also a retrospective study, randomized control studies investigating the effect of PPOS on the euploidy rate and on the live birth rate are warranted.