Oocyte cryo-preservation for fertility preservation: a comparative study of efficacy and cost-effectiveness between progestin-primed and antagonist ovarian stimulation protocol

Suppression of an LH surge is fundamental to successful oocyte retrieval after controlled ovarian stimulation. This study evaluates the efficacy and cost-effectiveness of progestin-primed ovarian stimulation (PPOS) using oral medroxyprogesterone acetate in fertility preservation cycles. The design is a retrospective single-centre study (January 2022-August 2023) comparing two ovarian stimulation protocols: PPOS and the gonadotrophin-releasing hormone antagonist (GnRHant) protocols. Cycles began at any time of the menstrual cycle. The primary outcome was the number of metaphase II oocytes retrieved. Secondary outcomes included total oocytes retrieved, maturity ratio, stimulation duration, incidence of premature LH rise/ovulation events, and the cost of medication used to prevent ovulation. The study included 125 fertility preservation cycles: 54 in the PPOS group and 71 in the GnRHant group. Median body mass index, antral follicle count, and anti-Mullerian hormone levels were comparable between the two groups. The median age was younger in the PPOS group; 28 years vs. 32 years, p = 0.03. Mature oocyte retrieval was similar; mean 9.33 [SD 5.87] vs. 8.97 [SD 5.44], p = 0.73. No premature LH rises occurred in either group. Secondary outcomes showed no significant differences, except for the cost of medication used to prevent ovulation. The PPOS protocol was considerably more cost-effective, by achieving a 98.06% cost reduction (medroxyprogesterone acetate, mean £4.38 [SD, £1.10] vs cetrorelix acetate £226.2 [SD £64.36], p= <0.0001. PPOS is a practical, cost-effective strategy for fertility preservation. Its appeal lies in its patient-centric focus, with a less invasive injection-based administration, while maintaining comparable effectiveness and significant cost reduction compared with the GnRH antagonist ovarian stimulation protocol.