COMPARISON OF CYCLE CHARACTERISTICS OF PATIENTS WITH UNEXPLAINED INFERTILITY TREATED WITH PROGESTIN PRIMED OVARIAN STIMULATION AND ANTAGONIST PROTOCOL

Abstract

Objective

The aim of controlled ovarian hyperstimulation (COH) in assisted reproductive techniques is to obtain the maximum number of mature oocytes required to achieve pregnancy. At this stage, where follicular development is simultaneously achieved, it is very important to prevent premature ovulation that may develop before the oocyte retrieval procedure and premature luteinizing hormone (LH) peak.(1) Gonadotropin-releasing hormone (GnRH) agonists and antagonists have been used for many years to prevent premature LH peak by suppressing the pituitary gland. Although GnRH agonists or antagonists provide satisfactory results in this regard, they create disadvantages for patients due to the discomfort caused by their daily injection and their high prices. Progestins, in addition to effectively suppressing the LH peak and ovulation, are also cheap and easy to use, which has led to numerous studies in recent years evaluating the effects of different progesterone preparations on different patient groups, and different progestin-primed ovarian stimulation (PPOS) protocols have been investigated.(2) In our study, we aimed to retrospectively compare the COH results obtained in patients who applied to our clinic with the indication of unexplained infertility and who were applied PPOS or antagonist protocols.

Materials and Methods

For our cross-sectional retrospective observational study, 138 patient data from the Health Sciences University Etlik Zübeyde Hanım Gynecology and Pediatrics Training and Research Hospital UYT/IVF unit, whose diagnosis, follow-up and treatments were planned, and whose COH results were obtained, between January 2022 and March 2023, were retrospectively scanned from the patient registration system. For COH purposes, 59 patients (42.1%) who were applied PPOS protocol and 81 patients (57.9%) who were applied antagonist protocol were divided into group1 and group2. Demographic, laboratory, stimulation data and oocyte characteristics of the groups were compared.

Results

Data of 59 patients (42.1%) who were applied PPOS protocol were compared in group1 and 81 patients (57.9%) who were applied antagonist protocol were compared in group2. No difference was observed between demographic data of the patients such as age, male age, infertility duration and BMI (p>0.05). (Table1) No difference was observed between basal FSH, LH, E2, AFC and AMH values of the patients in terms of ultrasonography and laboratory values ​​(p>0.05). (Table1) No difference was observed between clinical and COH results of the patients in terms of total gonadotropin dose, stimulation duration, number of oocytes collected and number of mature oocytes (p>0.05). (Table1)

Conclusions

In our study, similar results were observed between the PPOS protocol and the antagonist protocol. PPOS can be seen as a good alternative to antagonist protocols due to the advantage of oral use instead of daily injection and ease of access during natural disasters such as pandemics or earthquakes.