P-606 Fewer good-quality cleavage embryos in dydrogesterone-primed ovarian stimulation compared to GnRH antagonist protocol in POSEIDON group 4 patients Article Swipe
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· 2025
· Open Access
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· DOI: https://doi.org/10.1093/humrep/deaf097.912
· OA: W4411752554
Study question What would the average treatment effect have been had everyone in the treated population been given PPOS compared to GnRH-antagonist? Summary answer The PPOS group had a significantly lower number of good-quality cleavage and blastocyst embryos compared to the GnRH-ant group in both unadjusted and adjusted analyses. What is known already Due to the growing prevalence of POSEIDON group 4 patients and the paucity of studies comparing PPOS and GnRH-ant protocols in this specific population, optimizing ovarian stimulation strategies for these patients with poor prognosis remains crucial. Dydrogesterone appears to have a relatively weak suppressive effect on luteinizing hormone (LH), and its level was found higher compared to the GnRH-antagonist protocol, it could be beneficial in maintaining adequate endogenous LH for optimal follicular development, especially in older patients, it may also expose to a risk of premature LH surge with compromised oocyte quality if not properly controlled. Study design, size, duration We conducted a retrospective analysis of IVF cycles performed in women at our academic fertility center from January 1st, 2022 to March 1st, 2024. A total of 447 patients who met the criteria were included in the study, with 281 patients in the GnRH-ant group and 166 patients in the PPOS group. After propensity score matching, 165 patients from each group were selected for analysis. Participants/materials, setting, methods The eligible patients were POSEIDON Group 4 (age ≥35 years and antral follicle count (AFC) <5 or anti-Müllerian hormone (AMH) <1.2 ng/ml), treated with either PPOS or GnRH-ant protocol, and all resulting embryos were cryopreserved for subsequent frozen embryo transfer (freeze-all strategy). Exclusion criteria were: oocyte freezing and surgical sperm retrieval. The treatment effect of PPOS compared to GnRH-ant on oocyte and embryo outcomes was estimated unadjusted and adjusted by propensity score matching. Main results and the role of chance Main result: After propensity score matching, the PPOS group had a significantly lower number of good-quality cleavage embryos (1.52 ± 1.50 vs. 1.91 ± 1.96, adjusted mean ratio 0.80, 95% CI 0.66-0.97) and total blastocysts (1.61 ± 1.39 vs. 2.11 ± 1.82, adjusted mean ratio 0.77, 95% CI 0.62-0.96) compared to the GnRH-ant group. The number of good-quality blastocysts did not differ between the two groups. Although not statistically significant, the clinical pregnancy (31.4% vs 36.8%) and ongoing pregnancy rates (20.3% vs 29.9%) after the first embryo transfer tended to be lower in the PPOS group. The role of chance: The potential variability in outcomes that could occur due to random differences, despite propensity score matching to balance baseline characteristics. Statistical analyses, including adjusted and unadjusted models with confidence intervals, were used to estimate treatment effects and account for variability. Limitations, reasons for caution We acknowledge some limitations, including the retrospective design, and single-center setting which may limit the generalizability of our findings. Wider implications of the findings These findings highlight the need for caution when considering the PPOS protocol in poor prognosis patients and underscore the importance of tailoring ovarian stimulation strategies based on individual patient characteristics. Trial registration number No
