Progesterone-primed ovarian stimulation in oocyte donation: a model for elective fertility preservation?

Abstract

Research question: Does type of LH peak suppression (progesterone-primed ovarian stimulation [PPOS] versus gonadotrophin releasing hormone [GnRH] antagonist) affect oocyte competence, embryo development and live birth rates in recipients of vitrified donated oocytes?

Design: Retrospective cohort study conducted between 2016 and 2018, involving 187 recipient cycles of donated vitrified oocytes. Oocyte donors were stimulated under LH suppression with desogestrel for PPOS (DSG group) or ganirelix GnRH antagonist (ANT group). Recipients younger than 50 years received vitrified oocytes from DSG donation cycles (DSG-R) or ANT donation cycles (ANT-R).

Results: A mean of 10.07 ± 3.54 oocytes per recipient were warmed (survival rate of 80.7%), and 5.90 ± 2.89 were fertilized (fertilization rate 72.6%). Out of 187 recipients, 168 achieved embryo transfers. No significant differences were found in warming survival rates, fertilization rates and embryo development between DSG-R and ANT-R groups. Ninety-four clinical pregnancies and 81 live births were achieved. No statistically significant differences were found in clinical pregnancy rates (47.7% versus 52.5, P = 0.513) and live birth rates (39.5% versus 46.5%, P = 0.336) per recipient cycle between DSG-R and ANT-R, respectively. Multivariable logistic regression was applied to assess the effect of treating oocyte donors. Live birth rate adjusted for associated factors was not statistically different between vitrified oocytes from DSG or ANT (OR 0.74, 95% CI 0.37 to 1.47).

Conclusion: Reproductive outcomes of recipients of vitrified oocytes are not affected by donor PPOS treatment. PPOS is suitable for suppressing LH peak in elective fertility preservation and in freeze-all strategies.

Keywords: Elective fertility preservation; Fertility preservation; Oocyte donation; Progesterone primed ovarian stimulation.