JBRA Assisted Reproduction 2025;29(Suppl.2 SBRA 2025):59
Poster Presentation
29th Annual Congress of the SBRA. São Paulo/SP - Brazil, 2025
doi: 10.5935/1518-0557.20263598
P-47. Comparison Of Progestin-Primed Ovarian Stimulation and GnRH Antagonist Protocols with Deltafolitropin Stimulation in Assisted Reproductive Technology: a Multicenter Trial
Roberto de Azevedo Antunes1, Maria do Carmo Borges de Souza1, Marcelo Marinho de Souza1, Karina Abelha Rabaço1, Gabriela Palhano Sifuentes Melo1, Oscar Barbosa Duarte Filho2, Lucas Yugo Shigehara Yamakami2, Renato Bussadori Tomioka2, Larissa Matsumoto2, Fernanda Imperial Carneiro Liez2, Carlos Roberto Izzo3, Georges Fassolas3, Luiz Fernando Henrique3, Joyce Fioravantte3, João Antônio Dias Júnior3, Edson Borges Júnior4, Daniela Braga4, Maite del Collado Barrondo4, Emerson Barchi Cordts5, Ivan Henrique Yoshida5, Caio Parente Barbosa5
1 Fertipraxis Centro de Reprodução Humana - Rio de Janeiro - RJ - Brasil
2 Clínica Vida Bem Vinda Reprodução Humana - São Paulo - SP- Brasil
3 Originare Medicina Reprodutiva - São Paulo - SP - Brasil
4 Fertility Medical Group / FertGroup - São Paulo - SP - Brasil
5 Instituto Ideia Fértil de Saúde Reprodutiva - São Paulo - SP - Brasil
Objective: This study aimed to compare the efficacy of pituitary suppression with oral dydrogesterone (PPOS) versus GnRH antagonists in IVF/ICSI cycles undergoing preimplantation genetic testing for aneuploidy (PGT-A), with a focus on both laboratory and obstetric outcomes.
Methods: This was a retrospective, multicenter, comparative cohort study conducted at five private fertility centers. A total of 372 IVF/ICSI cycles with PGT-A, performed between January and December 2023, were included without age restrictions. All patients underwent ovarian stimulation with fixed daily doses of follitropin delta (Rekovelle®, Ferring Pharmaceuticals) and menotropin (Menopur®, Ferring Pharmaceuticals), stratified by age group. Pituitary suppression was achieved using either a GnRH antagonist (cetrorelix acetate, Cetrotide®, Merck) at 0.25 mg/day, initiated in a flexible regimen upon identification of a follicle ≥14 mm (n = 196), or dydrogesterone (DYG; Duphaston®, Abbott) at 10 mg every 8 hours, initiated on day 1 of stimulation and continued until the end of the stimulation phase (n = 176). The primary outcome was live birth rate at the first embryo transfer. Analyses were performed using generalized linear models (GLM), with results expressed as odds ratios (OR) and 95% confidence intervals (CI). Analyses were adjusted for age, BMI, presence of endometriosis, and PCOS. Statistical analyses were performed using IBM SPSS Statistics, version 29.0 (2023).
Results: Descriptive comparisons (table 1) using t-tests and chi-square tests showed no statistically significant differences between groups in baseline characteristics, including age (37.07±3.14 vs. 37.18 ± 3.37; p=0.733), BMI (24.04±3.67 . 23.64±3.17; p=0.306), AMH levels (2.64±2.56 vs. 2.61±2.15; p=0.921), number of follicles ≥16 mm (8.69 ± 6.42 vs. 7.74 ± 5.31; p = 0.118), and total oocytes retrieved (13.51 ± 8.70 vs. 14.54±7.88; p=0.234). However, statistically significant differences were observed in stimulation duration (10.48±1.57 vs. 9.85±1.20; p<0.001) and number of MII oocytes retrieved (10.33 ± 6.95 vs. 11.66 ± 6.10; p=0.050). While the live birth rate after the first embryo transfer was higher in the GnRH antagonist group, the difference did not reach statistical significance (50.51% vs. 41.47%; p=0.081). Despite a slight advantage in the studied outcome for the antagonist group, the GLM analysis showed no statistically significant difference between the groups.
Conclusions: The present study found no statistically significant difference between the PPOS and antagonist protocols with respect to the clinical outcome of live birth after first embryo transfer. However, the number of MII oocytes retrieved in the DYG group was higher than the aGnRH.