Embryo Ploidy and Ovarian Response in Gonadotropin-Releasing Hormone Antagonist Versus Progestin-Primed Ovarian Stimulation Protocols with Recombinant Luteinizing Hormone: A Within-Patient Study

Abstract

OBJECTIVE: To compare embryo ploidy rates and ovarian response outcomes between gonadotropin-releasing hormone (GnRH) antagonist and progestin-primed ovarian stimulation (PPOS) cycles with recombinant luteinizing hormone (rLH) administered from stimulation onset.

STUDY DESIGN: This retrospective within-patient cohort study included 41 women undergoing in vitro fertilization (IVF) with preimplantation genetic testing for aneuploidy (PGT-A) at a single center. Each patient completed both GnRH antagonist and PPOS cycles with rLH supplementation initiated on stimulation day 1. Cycles using GnRH agonists, urinary LH, random-start approaches, or with major gonadotropin dose discrepancies were excluded. The primary outcome was euploidy rate per biopsied blastocyst. Secondary outcomes included gonadotropin consumption, numbers of retrieved and mature oocytes, fertilization, blastulation, and euploidy per metaphase II (MII) oocyte. Paired t-tests or Wilcoxon signed-rank tests were used as appropriate. Statistical significance was set at p <0.05.

RESULTS: In total, 175 blastocysts were biopsied (86 antagonists; 89 PPOS). Euploidy rates per biopsied embryo were comparable (32.36% vs 33.72%). No significant differences were observed in oocyte yield, MII oocytes, fertilization, or blastulation rates. Gonadotropin consumption was significantly higher in antagonist cycles (p = 0.013), while hormonal profiles at trigger were comparable.

CONCLUSION: When rLH supplementation is standardized, PPOS and antagonist protocols yield comparable embryo ploidy and similar ovarian response in IVF-PGT-A cycles. PPOS remains an effective alternative, particularly in freeze-all strategies. Larger prospective studies are needed to clarify the benefit of rLH across stimulation protocols.