Initiation of ovarian stimulation independent of the menstrual cycle (random-start) in an oocyte donation programme a large, single-center experience

Abstract

Research Question Do live birth rates differ between recipients matched with donors using conventional ovarian stimulation versus those using random-start protocols? Design Retrospective analysis of 891 ovarian stimulations in egg donors (January-December 2018) and clinical outcomes in matched recipients (n=935). Donors commenced ovarian stimulation on day 1/3 of the menstrual cycle (n=223) or in the mid/late-follicular (n=388) or luteal phase (n=280) under a conventional antagonist protocol. Live birth rate of matched recipients was the main outcome. Results Duration of stimulation and total gonadotropins dose were comparable between conventional versus random-start groups. The number of collected eggs were also similar: 17.6±8.8 vs 17.2±8.5, p=0.6, respectively. Sub-group analysis showed an increased stimulation length (10.2±1.8 vs 9.8±1.7 vs 10.4±1.7, p<0.001) and gonadotropin consumption (2041.5±645.3 vs 2003.2±647.3 vs 2158.2±685.7 IU, p=0.01) in the luteal phase group vs the mid/late follicular and conventional groups; respectively. In matched recipients receiving fresh oocytes and undergoing fresh embryo transfer, the biochemical pregnancy (63.8% and 63.3%; p=0.9), clinical pregnancy (54.6% and 56.1%; p=0.8) and live birth rates (47.7% and 46.6%; p=0.7) per embryo-transfer were similar between conventional versus random groups. Similar results were obtained in recipients receiving vitrified eggs. Euploidy rate was also comparable. Conclusions There were no notable variations in clinical outcomes using oocytes obtained from random-start protocols and those proceeding from conventional ovarian stimulation in oocyte donation treatments. However, luteal-phase stimulation seems to require longer stimulation and higher FSH consumption. Our results indicate that random-start stimulation strategy does not impair the potential of the oocyte yield or clinical outcomes in oocyte donation cycles.