New Ovarian Stimulation With Random Start, Use of Progestin Protocol for Oocyte Donors

Medically assisted procreation can help infertile patients with a panel of techniques adapted to various causes of infertility. In most cases, these techniques use patients' own gametes. However, despite the medical advances, it is still impossible today to regenerate gametic cells when they have disappeared from the gonads. Especially for women with premature ovarian failure, the only feasible option is to receive oocytes from a third-party donor. In France, the principle of free and anonymous applies to the donation and no compensation is allowed outside the reimbursement of expenses incurred. Oocyte donors are women volunteers who agree to undergo heavy medical treatment to help other women, without any other consideration so that the recognition of their donation. It is important for these women to minimize the risks involved, to simplify and minimize ovarian stimulation treatments, which are generally injections and to offer maximum flexibility, without reducing the quality of the donation.

The advent of oocyte and embryo vitrification has opened up new opportunities for reproductive scientists to improve the practice and results of IVF attempts. It is now established that vitrification of whole oocyte cohorts does not compromise, and may even improve, the results of IVF attempts. In addition, it is now clear that progesterone modulates the frequency of Gonadotropin-Releasing Hormone (GnRH) pulses and can strongly inhibit the pulsatile secretion of GnRH and LH and thereby inhibit the LH peak induced by increased plasma concentrations of GnRH and LH. estradiol. And, in the context of oocyte donation, the deleterious effects of ovarian stimulation on endometrial receptivity have no impact: the increase in progesterone levels during stimulation is not a concern in this group who will not benefit from an embryonic transfer.

Initially, progesterone stimulation protocols were performed during the luteal phase as part of the urgent preservation of fertility in cancer patients. The first European feasibility study was conducted and published in 2013 in normotensive patients. While the preliminary findings were not optimistic, many publications, from 2013, showed that this luteal strategy is effective without the addition of a GnRH antagonist, but imposes a freeze all strategy. In all these studies, whether it is luteal phase stimulation schemes, strategies of 2 consecutive stimulations, in the follicular and then luteal phase, or random-start stimulation protocol, the quality of the oocytes does not seem to be impacted, with identical implantation and birth rates in the control groups (conventional ovarian stimulation). The state of health of newborns and malformation rates are also identical to those of conventional protocols.