P-403 Antagonist versus progestin-primed ovarian stimulation protocol for fertility preservation in cancer patients

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Abstract Study question Are the antagonist and progestin-primed ovarian stimulation (PPOS) protocols comparable in terms of effectiveness for fertility preservation in cancer patients? Summary answer Both protocols are effective; the antagonist protocol showed better oocyte maturation, while PPOS had more favorable vitrification and embryo freezing outcomes. What is known already Fertility preservation is crucial for cancer patients prior to potentially gonadotoxic treatments. Various ovarian stimulation protocols, such as the antagonist protocol and PPOS, are commonly used for in vitro fertilization (IVF). The antagonist protocol has shown promising results in IVF, while PPOS is considered more patient-friendly and cost-effective. Study design, size, duration This retrospective, observational study included cancer patients who underwent fertility preservation, between January 2015 and June 2024. A total of 548 cycles were analyzed, divided into two groups: the antagonist protocol group and the PPOS group. The study examined stimulation outcomes, including oocyte maturation rates, embryo freezing, and vitrification. Participants/materials, setting, methods Cancer patients eligible for fertility preservation received either the antagonist protocol or PPOS. The antagonist protocol used gonadotropins with a GnRH antagonist, while PPOS involved oral progestin. Hormone-dependent cancer patients were assigned to the antagonist protocol, associated with anti-aromatase. All patients had a random-start stimulation. Participants were monitored with regular ultrasonographic and hormonal assessments. Retrieved oocytes, embryo freezing, vitrification rates, and maturation were compared. Main results and the role of chance A total of 548 cycles were included, with 343 in the antagonist group and 205 in the PPOS group. The mean age was 28.46 years in the antagonist group and 25.60 years in the PPOS group (p < 0.001). Mean anti mullerian hormone (AMH) levels were comparable between the groups (p = 0.664) as well as the antral follicle count (AFC), (p = 0.362). The stimulation duration and the gonadotropin dose were significantly higher in the PPOS group (p = 0.026, p = 0.017). The number of retrieved oocytes was higher in the PPOS group (p = 0.003). The maturity rate was significantly higher in the antagonist group (65.61% vs. 59.80%, p = 0.007). Finally, vitrified oocytes and embryos were more frequent in the PPOS group (9.83 vs. 7.93, p = 0.006 for oocytes; 4.22 vs. 2.80, p = 0.038 for embryos). Limitations, reasons for caution This study has several limitations. First, it is retrospective and monocentric, which may limit the generalizability of the findings. Additionally, the groups were not age-matched, which could introduce bias in the results. Further prospective, multicenter studies with age-matched controls are needed to validate these findings and ensure broader applicability. Wider implications of the findings The PPOS protocol seems to be effective for fertility preservation in cancer patients. These findings offer valuable insights to oncologists and fertility specialists, aiding them in selecting the most appropriate protocol based on individual patient needs and clinical factors. Trial registration number No