Progestin-primed ovarian stimulation: for whom, when and how?

Area of Science:

• Reproductive Endocrinology
• Assisted Reproductive Technology

Background:

• Progestin-primed ovarian stimulation (PPOS) is gaining traction in assisted reproductive technology (ART).
• Various progestins demonstrate similar efficacy in PPOS protocols.
• PPOS offers potential advantages over traditional gonadotrophin-releasing hormone (GnRH) analogue protocols.

Purpose of the Study:

• To compare the efficacy and cost-effectiveness of PPOS versus GnRH analogue protocols in ART.
• To evaluate oocyte developmental potential and embryo transfer outcomes between the two stimulation methods.
• To assess the safety and patient-friendliness of PPOS across diverse patient populations.

Main Methods:

• Systematic review and analysis of existing studies comparing PPOS and GnRH analogue protocols.
• Evaluation of key performance indicators including stimulation duration, gonadotrophin consumption, oocyte yield, blastocyst euploidy rates, and pregnancy/live birth rates.
• Cost-effectiveness analysis considering medication costs and cycle outcomes.

Main Results:

• PPOS and GnRH analogue protocols show similar ovarian stimulation responses, with minor, clinically insignificant differences in stimulation duration and gonadotrophin use.
• Oocytes retrieved via PPOS exhibit comparable developmental potential, including similar blastocyst euploidy rates.
• Frozen embryo transfer outcomes, including ongoing pregnancy/live birth rates and obstetric/perinatal results, are similar between PPOS and GnRH analogue cycles.
• PPOS demonstrates superior cost-effectiveness for fertility preservation and freeze-all cycles due to oral administration and lower medication costs.

Conclusions:

• PPOS is a patient-friendly and cost-effective option for assisted reproduction, especially when fresh embryo transfer is not intended.
• While PPOS can be less cost-effective for fresh embryo transfer cycles due to potential additional frozen embryo transfer costs, its overall outcomes are comparable to GnRH analogue protocols.
• PPOS has demonstrated consistent results across various patient types, excluding those with progesterone receptor-positive breast cancer.