Euploidy rates are comparable between progestin protocol ovarian stimulation and gonadotropin-releasing hormone antagonist protocol ovarian stimulation cycles

Abstract

To compare blastocyst euploidy rates between progestin protocol ovarian stimulation and gonadotropin-releasing hormone (GnRH) antagonist protocol ovarian stimulation cycles. Design Retrospective cohort study. Subjects Women undergoing assisted reproductive technology cycles with their own oocytes. Exposure Ovarian stimulation was commenced on day 2/3 of the cycle, and either the GnRH-antagonist protocol was employed or the progestin protocol with dydrogesterone at a dose of 30 mg/d in three divided doses was started on the same day with gonadotropins or the day after and continued until (including) the day of final oocyte maturation. Main Outcome Measures Blastocyst euploidy rates. Results A total of 4,755 stimulation cycles were included in the study, and 973 GnRH antagonist and 398 propensity score-matched progestin protocol cycles were included in the analyses. In bivariate comparisons, mature oocyte yield, number of zygotes, blastocysts, euploid blastocysts, and euploidy rate per biopsied blastocyst were similar between the groups. Multivariable mixed-effects regression analyses adjusted for confounders showed similar oocyte count (incidence rate ratios [IRR] 0.96, 95% confidence interval [CI] 0.89–1.03), mature oocyte count (IRR 0.95, 95% CI 0.87–1.03), blastocyst count (IRR 1.12, 95% CI 0.97–1.29), and euploid blastocyst count (IRR 1.08, 95% CI 0.86–1.36). Euploidy rate per biopsy was similar between the progestin protocol and the GnRH antagonist protocol, and no significant interaction was detected between the protocol and patient age. Twenty-nine individuals, who underwent two stimulation cycles, one with progestin protocol and another with GnRH antagonist protocol, in any order, within the same calendar year, had similar metaphase II oocyte yields, blastocyst counts, and euploidy rates with both protocols. Conclusion The present study provides reassurance about the newer progestin protocol by demonstrating similar euploidy rates of blastocysts with GnRH antagonist protocols.