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Journal of Assisted Reproduction and Genetics

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13-11-2024 | Progestin | Assisted Reproduction Technologies

A multicycle approach through DuoStim with a progestin-primed ovarian stimulation (PPOS) protocol: a valuable option in poor prognosis patients undergoing PGT-A

Authors: Alberto Vaiarelli, Erika Pittana, Danilo Cimadomo, Alessandro Ruffa, Silvia Colamaria, Cindy Argento, Maddalena Giuliani, Pasquale Petrone, Gemma Fabozzi, Federica Innocenti, Marilena Taggi, Baris Ata, Laura Rienzi, Filippo Maria Ubaldi

Published in: Journal of Assisted Reproduction and Genetics | Issue 1/2025

Abstract

Purpose

This study is to evaluate the effectiveness of a PPOS protocol in poor prognosis patients undergoing IVF with DuoStim and PGT-A versus the conventional protocol with GnRH antagonist.

Methods

Retrospective cohort study encompassing 444 couples obtained matching one PPOS-DuoStim with two antagonist-DuoStim cycles at a private IVF center between 2020 and 2023 (average maternal age: 40 years, average cumulus–oocyte complexes collected after the first stimulation: 5). The study was powered to exclude a two-sided different euploid blastocyst rate per MII oocytes (EBR per MII) in the two groups (alpha = 0.05, power = 0.9, effect size = 0.3). All cycles involved ICSI, blastocyst stage PGT-A, and single vitrified-warmed euploid transfers. We compared all embryological and clinical outcomes within each group (first vs. second stimulations), and among the two study arms (first stimulation vs. first stimulation; second stimulations vs. second stimulation; overall). The overall EBR per MII was the primary study outcome. The cumulative-live-birth-rate per concluded cycles (CLBR) was the main secondary outcome.

Results

In the second stimulations, we obtained a greater number of COCs and MIIs in both antagonist- and PPOS-DuoStim groups. No difference was observed for all embryological and clinical outcomes when comparing the two stimulations within each group. All embryological and clinical outcomes were comparable also between the two groups, including the EBR per MII. To date, 285 and 121 antagonist- and PPOS-DuoStim cycles were concluded. The CLBR was comparable between the groups: 26% vs. 29%.

Conclusions

PPOS-DuoStim holds potential for being an efficient, patient-friendly, and possibly cost-effective approach that does not compromise treatment efficacy. Future investigations must explore PPOS effect on follicular recruitment, neonatal, and long-term outcomes.

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Title: A multicycle approach through DuoStim with a progestin-primed ovarian stimulation (PPOS) protocol: a valuable option in poor prognosis patients undergoing PGT-A
Authors: Alberto Vaiarelli
Erika Pittana
Danilo Cimadomo
Alessandro Ruffa
Silvia Colamaria
Cindy Argento
Maddalena Giuliani
Pasquale Petrone
Gemma Fabozzi
Federica Innocenti
Marilena Taggi
Baris Ata
Laura Rienzi
Filippo Maria Ubaldi
Publication date: 13-11-2024
Publisher: Springer US
Keyword: Progestin
Published in: Journal of Assisted Reproduction and Genetics / Issue 1/2025
Print ISSN: 1058-0468
Electronic ISSN: 1573-7330
DOI: https://doi.org/10.1007/s10815-024-03317-0

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A multicycle approach through DuoStim with a progestin-primed ovarian stimulation (PPOS) protocol: a valuable option in poor prognosis patients undergoing PGT-A

Abstract

Purpose

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Results

Conclusions

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