Progestin-primed Ovarian Stimulation In Patients With Implantation Failures By GnRH Agonist Long Protocol Undergoing IVF/ICSI

ObjectiveTo explore the effect of PPOS(Progestin-primed ovarian stimulation)in patients with failures by long protocol,and to analyze the embryology feature and pregnancy outcome.MethodsThis retrospective study was conducted from January 2014 to December 2016.Infertile women underwent IVF/ICSI(In vitro fertilization/ Intracytoplasmic sperm injection)treatments have ≥2 times of implantation failures by long protocol in other hospitals,with normal ovarian reserve.This study is a self-control study,aiming to compare the number of retrieved oocyte,viable embryos,clinical pregnancy rate and live birth rate between PPOS and previously failed long protocol.Procedure of PPOS regimen: Patients were administered h MG(Human Menopausal Gonadotrophin)150-225IU/d and MPA(Medroxyprogesterone 17-acetate)4–10 mg/d from MC3(Menstrual cycle day 3).Results1.The number of retrieved oocytes and viable embryos in PPOS were significantly lower than long protocol(P <0.001).Patients who failed in long protocol implantation,gained the clinical pregnancy rate,implantation rate and live-birth rate of 49.2%(163/331),31.4%(194/618)and 41.7%(138/331),in FET cycles of PPOS.2.When comparing the groups using different implantation methods of long protocol,all pregnancy outcomes had no significant difference.Patients who only operated FET cycles in long protocol,gained the clinical pregnancy rate,implantation rate and live birth rate of 50.7%(37/73),30.2%(41/136)and 41.1%(30/73),in FET cycles of PPOS.3.Patients who suffered at least 4 implantation failures in long protocol,when receiving FET cycles in PPOS,the clinical pregnancy rate,implantation rate and live birth rate are 41.5%(27/65),23.2%(29/125)and 32.3%(21/65).ConclusionPatients with implantation failures by Gn RH agonist long protocol could obtain competent embryos and improved pregnancy outcomes in PPOS.The main effect of PPOS might be the improvement of oocytes and embryos quality,associated with difference of endocrine profile between PPOS and long protocol.PPOS could be an efficient alternative regimen for patients with implantation failures in long protocol.