Random-start ovarian stimulation in an oocyte donation programme: a large, single-centre, experience

Area of Science:

• Reproductive Medicine
• Infertility Treatment
• Oocyte Donation

Background:

• Conventional ovarian stimulation protocols typically begin on days 1-3 of the menstrual cycle.
• Random-start protocols offer flexibility by initiating stimulation in the mid/late follicular or luteal phases.
• Assessing the impact of different ovarian stimulation protocols on oocyte donation outcomes is crucial for optimizing treatment success.

Purpose of the Study:

• To compare live birth rates between egg recipients whose donors underwent conventional ovarian stimulation versus random-start protocols.
• To evaluate if random-start protocols affect oocyte yield and clinical pregnancy outcomes in oocyte donation.

Main Methods:

• Retrospective analysis of 891 ovarian stimulations in egg donors and 935 matched recipients.
• Donors were categorized into conventional (days 1-3), mid/late follicular phase, or luteal phase random-start groups.
• Live birth rate per embryo transfer was the primary outcome measure, with secondary analysis of pregnancy rates and euploidy.

Main Results:

• Oocyte yield and live birth rates were comparable between conventional and random-start protocols (47.7% vs. 46.6%, P=0.7).
• Stimulation duration and gonadotropin consumption varied significantly between groups, with luteal-phase stimulation requiring more resources.
• Biochemical, clinical pregnancy, and euploidy rates showed no significant differences between the stimulation strategies.

Conclusions:

• Random-start ovarian stimulation protocols are a viable alternative to conventional methods in oocyte donation, yielding similar live birth rates.
• The flexibility of random-start protocols does not compromise oocyte quality or recipient outcomes.
• Luteal-phase stimulation may necessitate longer treatment duration and higher gonadotropin doses.