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Comparison of euploidy rates between progestin-primed ovarian stimulation and GnRH antagonist protocols: a
Caroline Ingold1, Giovanna Giovacchini Dos Santos1, Caio Parente Barbosa1
1Instituto Ideia Fertil, Centro Universitário FMABC, Santo André, SP, Brazil.
Objective:
To compare the euploidy rate between ovulation suppression protocols using PPOS and GnRH-ant, and to evaluate possible variables associated with euploidy rate such as age, BMI, infertility duration, treatment-related factors, and semen parameters, in a genetically admixed Brazilian population underrepresented in reproductive medicine research.
Design:
This was a retrospective non-inferiority case-control study including 268 IVF cycles, conducted between 2021 and 2022. Subjects: A total of 268 in vitro fertilization (IVF) cycles were included, all with indication for preimplantation genetic testing for aneuploidy (PGT-A), of which 64.5% (n = 173) were included in the PPOS group, and 35.5% (n = 95) in the GnRH-ant group. A statistical power of 85% was achieved for the primary outcome.
Exposure:
Patients underwent controlled ovarian stimulation using either progestin-primed ovarian stimulation (PPOS) or GnRH antagonist (GnRH-ant) protocols.
Main Outcome Measures:
The primary outcome was the euploidy rate in PPOS and GnRH-ant groups.
Results:
No significant differences were observed in euploidy rate between the PPOS and GnRH-ant groups (25.9% vs. 27.5%; p = 0.865; r = 0.01). In the adjusted analysis, stimulation protocol was not significantly associated with euploidy rate (coefficient = 3.38; 95% CI: -14.26 to 16.03), whereas maternal age remained significantly and negatively associated with the outcome (coefficient = -7.83; 95% CI: -11.85 to -3.81). Fertilization rate was higher in the GnRH-ant group (p = 0.004), but this did not affect embryo formation or euploidy outcomes. Paternal age and semen parameters were not significantly associated with euploidy.
Conclusion:
According to the prespecified criterion, PPOS met the formal criterion for non-inferiority in relation to GnRH-ant regarding euploidy rate, although with limited margin. These findings support PPOS as a viable option in freeze-all/PGT-A cycles, but they should be interpreted with caution given the retrospective design and baseline differences between groups.
