Euploidy rates among preimplantation genetic testing for aneuploidy cycles with oral dydrogesterone primed ovarian stimulation or GnRH antagonist protocol

Research question: Do differences exist in euploidy rates in preimplantation genetic testing for aneuploidy (PGT-A) cycles with oral dydrogesterone primed ovarian stimulation protocol or the flexible gonadotropin-releasing hormone (GnRH) antagonist protocol? Design: A retrospective cohort study. Patients received the oral dydrogesterone or the GnRH antagonist in the first PGT-A cycle between November 2017 and May 2019. Propensity matching was used to identify a propensity-matched antagonist group based on age, BMI and AMH with a 1:1 ratio. The primary outcome was the rate of euploid embryos. Results: A total of 780 cycles were included, consisting of 390 cycles receiving dydrogesterone and 390 cycles receiving GnRH antagonist protocol. No significant difference was found in patient baseline and cycle characteristics in the two groups. No statistical difference was found in the number of oocytes retrieved, metaphase II oocytes, embryos biopsied and embryo testing between the two groups. As no biopsy blastocysts formed in some cycles, only 262 cycles in the study group and 263 cycles in the antagonist group received next-generation sequencing testing, respectively. Similar to our overall data, the euploid rate per embryo biopsied was not significantly different. No significant differences were found between the two groups after stratifying by age and controlling for PGT-A testing modality. Conclusions: Ovulation inhibition by exogenous progestins in ovarian stimulation cycles should, therefore, be considered a valid modality in freeze-all PGT-A cycles, in view of its demonstrated effectiveness and known safety enhancement.

Automated summary

This study aimed to compare the euploidy rates in PGT-A cycles using oral dydrogesterone or GnRH antagonist protocol. In a retrospective cohort study, no significant differences were found between the two groups after propensity matching based on age, BMI, and AMH. Additionally, there were no significant differences in the number of oocytes retrieved, embryos biopsied, and embryo testing.