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Outcomes of fertility preservation in women with endometriosis: comparison of progestin-primed ovarian stimulation versus antagonist protocols

BACKGROUND: PPOS protocols, initially described for FP in women with cancer, have many advantages compared to antagonist protocols. PPOS protocols were not evaluated for women with endometriosis. The objective of the study was to describe fertility preservation outcomes in women with endometriosis a...

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Autores principales: Mathieu d’Argent, Emmanuelle, Ferrier, Clément, Zacharopoulou, Chrysoula, Ahdad-Yata, Naouel, Boudy, Anne-Sophie, Cantalloube, Adèle, Levy, Rachel, Antoine, Jean-Marie, Daraï, Emile, Bendifallah, Sofiane
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7020543/
https://www.ncbi.nlm.nih.gov/pubmed/32054493
http://dx.doi.org/10.1186/s13048-020-00620-z
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author Mathieu d’Argent, Emmanuelle
Ferrier, Clément
Zacharopoulou, Chrysoula
Ahdad-Yata, Naouel
Boudy, Anne-Sophie
Cantalloube, Adèle
Levy, Rachel
Antoine, Jean-Marie
Daraï, Emile
Bendifallah, Sofiane
author_facet Mathieu d’Argent, Emmanuelle
Ferrier, Clément
Zacharopoulou, Chrysoula
Ahdad-Yata, Naouel
Boudy, Anne-Sophie
Cantalloube, Adèle
Levy, Rachel
Antoine, Jean-Marie
Daraï, Emile
Bendifallah, Sofiane
author_sort Mathieu d’Argent, Emmanuelle
collection PubMed
description BACKGROUND: PPOS protocols, initially described for FP in women with cancer, have many advantages compared to antagonist protocols. PPOS protocols were not evaluated for women with endometriosis. The objective of the study was to describe fertility preservation outcomes in women with endometriosis and to compare an antagonist protocol with a Progestin-Primed Ovarian Stimulation (PPOS) protocol. METHOD: We conducted a prospective cohort study associated with a cost-effectiveness analysis in a tertiary-care university hospital. The measured outcomes included the numbers of retrieved and vitrified oocytes, and direct medical costs. In the whole population, unique and multiple linear regressions analysis were performed to search for a correlation between individual characteristics and the number of retrieved oocyte. RESULTS: We included 108 women with endometriosis who had a single stimulation cycle performed with either an antagonist or a PPOS protocol. Overall, 8.1 ± 6.6 oocytes were retrieved and 6.4 ± 5.6 oocytes vitrified per patient. In the multiple regression model, age (p = 0.001), prior ovarian surgery (p = 0.035), and anti-Mullerian hormone level (p = 0.001) were associated with the number of retrieved oocytes. Fifty-four women were stimulated with an antagonist protocol, and 54 with a PPOS protocol. A mean of 7.9 ± 7.4 oocytes were retrieved in the antagonist group and 8.2 ± 5.6 in the PPOS group (p = 0.78). A mean of 6.4 ± 6.4 oocytes were vitrified in the antagonist group and 6.4 ± 4.7 in the PPOS group (p = 1). In the cost-effectiveness analysis, the PPOS protocol was strongly dominant over the antagonist protocol. CONCLUSION: Fertility preservation procedures are feasible and effective for patients affected by endometriosis. Antagonist and PPOS protocols were associated with similar results but the medico-economic analysis was in favor of PPOS protocols.
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spelling pubmed-70205432020-02-20 Outcomes of fertility preservation in women with endometriosis: comparison of progestin-primed ovarian stimulation versus antagonist protocols Mathieu d’Argent, Emmanuelle Ferrier, Clément Zacharopoulou, Chrysoula Ahdad-Yata, Naouel Boudy, Anne-Sophie Cantalloube, Adèle Levy, Rachel Antoine, Jean-Marie Daraï, Emile Bendifallah, Sofiane J Ovarian Res Research BACKGROUND: PPOS protocols, initially described for FP in women with cancer, have many advantages compared to antagonist protocols. PPOS protocols were not evaluated for women with endometriosis. The objective of the study was to describe fertility preservation outcomes in women with endometriosis and to compare an antagonist protocol with a Progestin-Primed Ovarian Stimulation (PPOS) protocol. METHOD: We conducted a prospective cohort study associated with a cost-effectiveness analysis in a tertiary-care university hospital. The measured outcomes included the numbers of retrieved and vitrified oocytes, and direct medical costs. In the whole population, unique and multiple linear regressions analysis were performed to search for a correlation between individual characteristics and the number of retrieved oocyte. RESULTS: We included 108 women with endometriosis who had a single stimulation cycle performed with either an antagonist or a PPOS protocol. Overall, 8.1 ± 6.6 oocytes were retrieved and 6.4 ± 5.6 oocytes vitrified per patient. In the multiple regression model, age (p = 0.001), prior ovarian surgery (p = 0.035), and anti-Mullerian hormone level (p = 0.001) were associated with the number of retrieved oocytes. Fifty-four women were stimulated with an antagonist protocol, and 54 with a PPOS protocol. A mean of 7.9 ± 7.4 oocytes were retrieved in the antagonist group and 8.2 ± 5.6 in the PPOS group (p = 0.78). A mean of 6.4 ± 6.4 oocytes were vitrified in the antagonist group and 6.4 ± 4.7 in the PPOS group (p = 1). In the cost-effectiveness analysis, the PPOS protocol was strongly dominant over the antagonist protocol. CONCLUSION: Fertility preservation procedures are feasible and effective for patients affected by endometriosis. Antagonist and PPOS protocols were associated with similar results but the medico-economic analysis was in favor of PPOS protocols. BioMed Central 2020-02-13 /pmc/articles/PMC7020543/ /pubmed/32054493 http://dx.doi.org/10.1186/s13048-020-00620-z Text en © The Author(s) 2020 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Mathieu d’Argent, Emmanuelle
Ferrier, Clément
Zacharopoulou, Chrysoula
Ahdad-Yata, Naouel
Boudy, Anne-Sophie
Cantalloube, Adèle
Levy, Rachel
Antoine, Jean-Marie
Daraï, Emile
Bendifallah, Sofiane
Outcomes of fertility preservation in women with endometriosis: comparison of progestin-primed ovarian stimulation versus antagonist protocols
title Outcomes of fertility preservation in women with endometriosis: comparison of progestin-primed ovarian stimulation versus antagonist protocols
title_full Outcomes of fertility preservation in women with endometriosis: comparison of progestin-primed ovarian stimulation versus antagonist protocols
title_fullStr Outcomes of fertility preservation in women with endometriosis: comparison of progestin-primed ovarian stimulation versus antagonist protocols
title_full_unstemmed Outcomes of fertility preservation in women with endometriosis: comparison of progestin-primed ovarian stimulation versus antagonist protocols
title_short Outcomes of fertility preservation in women with endometriosis: comparison of progestin-primed ovarian stimulation versus antagonist protocols
title_sort outcomes of fertility preservation in women with endometriosis: comparison of progestin-primed ovarian stimulation versus antagonist protocols
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7020543/
https://www.ncbi.nlm.nih.gov/pubmed/32054493
http://dx.doi.org/10.1186/s13048-020-00620-z
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