Experience of in vitro fertilization programmes with donor oocytes in micronized progesterone protocols

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OBJECTIVE

To study the micronized progesterone influence at stimulation of superovulation on the euploid embryos development rate, obtained by donor oocytes fertilization in cycles of in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI).

MATERIAL AND METHODS

A retrospective cohort study included 201 oocyte donors, women of reproductive age with preserved ovarian reserve, who underwent superovulatory stimulation from January 2018 to September 2020 at the PERSONA International Clinical Reproductology Center, Almaty, Kazakhstan. All oocyte donors were divided into 2 groups: The 1st group (main group) was represented by 108 oocyte donors who underwent superovulatory stimulation by progestin — micronized progesterone protocol; the 2nd (control) group consisted of 93 oocyte donors who underwent gonadotropin-releasing hormone (GnRH) antagonist protocols. Donors included in the main group were stimulated from day 2 or 3 of the menstrual cycle with recombinant follicle stimulating hormone (rFSH) and human menopausal gonadotropin (hMG); micronized progesterone 200 mg per day orally was used to suppress ovulation. Ovulation was induced by GnRH agonists and human chorionic gonadotropin when 2 or more dominant follicles matured. For the control group, a protocol with GnRH antagonists (Cetrorelix) at a dose of 0.25 mg per day was used. The donor oocytes obtained were fertilized by IVF or ICSI, depending on sperm quality. All embryos were cultured until 5—6 days of age, and embryos with good morphology were cryopreserved by vitrification with a preliminary biopsy of the trophectoderm. The obtained biopsy specimens were analysed by Microarray-based Comparative Genomic Hybridisation (aCGH). The main controls were the number of extracted oocytes, their maturity, fertilisation rate, percentage of blastulae, number of embryos at day 5 or 6 with good morphology and the percentage of euploid embryos after aCGH test.

RESULTS

The number of mature oocytes did not differ significantly between the examined groups, being 21.7±1.5 in Group 1 and 19.38±1.7 in Group 2 (80 and 81%, respectively). The mean number of fertilized oocytes was 17.6±0.8 in group 1 and 15.9±1.1 in group 2, thus the fertilization rate in the two groups had no difference (81.1% in group 1 versus 82.04% in group 2; p>0.05). The blastocyte rate (51.4% in group 1 and 53.5% in group 2; p>0.05) had no significant difference in both the micronized progesterone and GnRH antagonist (Cetrorelix) groups. The number of blastocytes of the highest quality was 6.4±2.1 (68.8%) in Group 1 versus 5.05±1.9 (66.4%) in Group 2 (p>0.05). The euploidy index of the embryos in both groups also had no statistically significant difference: 51% versus 49% (p>0.05).

CONCLUSION

The superovulatory stimulation protocol with micronized progesterone combined with cryopreservation of embryos is no less effective than the protocol with GnRH antagonists in IVF/ICSI cycles. The protocol with micronised progesterone can provide comparable embryological and clinical results. This protocol has no effect on the degree of embryo euploidy.

Keywords:

IVF

ICSI

oocyte donation

progestin-pregnant ovarian stimulation

GnRH antagonists

euploidy embryos

preimplantation genetic screening

Authors:

Lokshin V.N.

Abshekenova A.T.

International Clinical Center for Reproductology PERSONA;
NAO S. Asfendiyarov Kazakh National Medical University

Rybina A.N.

International Clinical Center for Reproductology PERSONA;
NAO S. Asfendiyarov Kazakh National Medical University

Askar E.

International Clinical Center for Reproductology PERSONA;
NAO S. Asfendiyarov Kazakh National Medical University

Karibaeva Sh.K.

International Clinical Center for Reproductology PERSONA;
NAO S. Asfendiyarov Kazakh National Medical University

Valiev R.K.

International Clinical Center for Reproductology PERSONA

Received:

04.06.2022

Accepted:

30.06.2022

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