Application of three kinds of ovulation induction in in vitro fertilization/intracytoplasmic sperm injection patients with poor ovarian response

Abstract

Objective To investigate the effect ofclomiphene(CC)+letrozole(LE) microstimulation protocol, medroxyprogesterone acetate (MPA) microstimulation protocol and antagonist protocol inin vitrofertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET) cycles of patients with poor ovarian response (POR). Methods All data were collected from October 2015 to December 2016. A retrospective cohort study was used to analyze 1 427 infertile women with POR, who underwent IVF/ICSI cycle with CC+LE+human menopausal gonadotropin (hMG) protocol (group A, 674 cycles), MPA+hMG protocol (group B, 496 cycles) and antagonist protocol (group C, 257 cycles). Then we observed and compared the the clinical and laboratory outcomes of the 3 groups. Results Gn used dosage [(2 590.88±742.85) IU] and duration [(9.3±2.3) d] in group A were significantly lower than that in groupB [(2 739.11±862.84) IU, (9.8±2.9) d] (P=0.006, P=0.002) and group C [(2 765.22±714.43) IU, (9.9±2.8) d] (P=0.003,P=0.007), In group A, the number of eggs (3.6±2.7) and two pronucleus (2PN) [2 (1,3)] were significantly more than those of group B [(3.0±2.6), 1 (1,3)] (P=0.002,P=0.015). Antagonist protocol resulted in the highest number of eggs (4.4±2.7), 2PN [2 (1,4)], available embryos [2 (1,3)] and high-quality embryos [1 (0,2)] than group A [3.6±2.7, 2 (1,3), 1 (1,2.25), 0 (0,1)] (P 0.05). But the oocyte free rate of group A (4.5%) was significantly lower than that of group B (8.2%) (P=0.008) and group C (9.7%) (P=0.002). The rate of clinical pregnancy in groups A-C were seprately 27.3%, 24.5%, 29.7%, the cumulative pregnancy rate was seprately 34.6%, 29.6%, 35.2%, and the live birth rate was separately 22.7%, 20.2%, 25.7%, there were no significant differences among 3 groups (P>0.05). Conclusion Similarly to GnRH-A protocol, CC+LE+hMG protocol and MPA+hMG protocol have a better effect of down-regulation. For patients with POR, the antagonist protocol was better than microstimulation protocol in the number of retrived oocytes, available embryos and the high-quality embryos. In the 2 microstimulation protocols, CC+LE protocol used less Gn but obstained more oocytes compared with MPA protocol. The clinical pregnancy rate, the cumulative pregnancy rate and the live birth rate are not significantly different among the 3 protocols. Key words: Poor ovarian response (POR); Letrozole (LE); Clomiphene (CC); Medroxyprogesterone acetate (MPA); Gonadotropin-releasing hormone antagonist (GnRH-A)