Objective: To outline oocyte competence after progestin primed ovarian stimulation with Norethisterone acetate (NETA-PPOS) compared to conventional GnRH-antagonist protocol.
Study Design: Retrospective matched case-control study involving advanced-maternal-age women undergoing ICSI with PGT-A. 89 NETA-PPOS were matched with 178 control patients based on maternal age and ovarian reserve biomarkers. Both groups underwent recombinant-FSH OS with GnRH-agonist ovulation trigger and collected ≥1 MII. In the study group, NETA (10 mg/day) was administered orally starting from day2 of the menstrual cycle. Euploid blastocyst rate per cohort of metaphase-II oocytes (EBR per MII) was the primary outcome. All other embryological and clinical outcomes were reported. Gestational age, birthweight and length were also assessed.
Results: The EBR per MII was comparable among PPOS and control (13.9 % ± 19.3 % versus 13.3 % ± 17.9 %; the sample size allowed to exclude up to a 10 % difference). Blastocysts morphology and developmental rate were similar. No difference was reported for all clinical outcomes among the 61 and 107 vitrified-warmed euploid single blastocyst transfers respectively conducted. The cumulative live birth delivery rate per concluded cycles was also comparable (24.7 % versus 21.9 %). Neonatal outcomes were analogous.
Conclusions: Oocyte competence after NETA-PPOS and standard OS is comparable. This evidence is reassuring and, because of its lower cost and possibly higher patients' compliance, supports PPOS administration whenever the patients are indicated to freeze-all (e.g., fertility preservation, PGT-A, oocyte donation). More data are required about follicle recruitment, oocyte yield, gestational and perinatal outcomes. Randomized-controlled-trials are advisable to confirm our evidence.
Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Danilo Cimadomo reports a relationship with Merck KGaA that includes: speaking and lecture fees and travel reimbursement. Danilo Cimadomo reports a relationship with Fairtility that includes: speaking and lecture fees and travel reimbursement. Danilo Cimadomo reports a relationship with Organon & Co. Inc. that includes: speaking and lecture fees and travel reimbursement. Danilo Cimadomo reports a relationship with IBSA Farmaceutici Italia Srl that includes: speaking and lecture fees and travel reimbursement. Alberto Vaiarelli reports a relationship with Theramex Italy Srl that includes: speaking and lecture fees and travel reimbursement. Alberto Vaiarelli reports a relationship with IBSA Farmaceutici Italia Srl that includes: speaking and lecture fees and travel reimbursement. Alberto Vaiarelli reports a relationship with Organon & Co. Inc. that includes: speaking and lecture fees and travel reimbursement. Alberto Vaiarelli reports a relationship with Merck KGaA that includes: speaking and lecture fees and travel reimbursement. Alberto Vaiarelli reports a relationship with Cook Medical Inc that includes: speaking and lecture fees and travel reimbursement. Filippo Maria Ubaldi reports a relationship with Merck KGaA that includes: speaking and lecture fees and travel reimbursement. Filippo Maria Ubaldi reports a relationship with Organon & Co. Inc. that includes: speaking and lecture fees and travel reimbursement. Filippo Maria Ubaldi reports a relationship with Ferring Pharmaceuticals Inc that includes: speaking and lecture fees and travel reimbursement. Filippo Maria Ubaldi reports a relationship with IBSA Farmaceutici Italia Srl that includes: speaking and lecture fees and travel reimbursement. Filippo Maria Ubaldi reports a relationship with CooperSurgical Inc that includes: speaking and lecture fees and travel reimbursement. Filippo Maria Ubaldi reports a relationship with Cook Medical Inc that includes: speaking and lecture fees and travel reimbursement. Filippo Maria Ubaldi reports a relationship with FUJIFILM Irvine Scientific Inc that includes: speaking and lecture fees and travel reimbursement. Laura Rienzi reports a relationship with Merck KGaA that includes: speaking and lecture fees and travel reimbursement. Laura Rienzi reports a relationship with Organon & Co. Inc. that includes: speaking and lecture fees and travel reimbursement. Laura Rienzi reports a relationship with Ferring Pharmaceuticals Inc that includes: speaking and lecture fees and travel reimbursement. Laura Rienzi reports a relationship with IBSA Farmaceutici Italia Srl that includes: speaking and lecture fees and travel reimbursement. Laura Rienzi reports a relationship with CooperSurgical Inc that includes: speaking and lecture fees and travel reimbursement. Laura Rienzi reports a relationship with Cook Medical Inc that includes: speaking and lecture fees and travel reimbursement. Laura Rienzi reports a relationship with FUJIFILM Irvine Scientific Inc that includes: speaking and lecture fees and travel reimbursement. Carlo Alviggi reports a relationship with Merck KGaA that includes: speaking and lecture fees and travel reimbursement. Carlo Alviggi reports a relationship with Organon & Co. Inc. that includes: speaking and lecture fees and travel reimbursement.
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