Abstract
ObjectiveTo compare the cumulative live birth rate (CLBR) of a gonadotropin-releasing hormone (GnRH) antagonist regimen and a progestin-primed ovarian stimulation (PPOS) regimen in low-prognosis patients according to POSEIDON criteria.DesignSingle-center, retrospective, observational study.SettingHenan Provincial People’s Hospital, Zhengzhou, ChinaPatientsWomen aged ≤40 years, with a body mass index <25 kg/m2, who underwent in vitro fertilization (IVF) or intracytoplasmic sperm microinjection (ICSI) and met POSEIDON low-prognosis criteria.InterventionGnRH or PPOS regimen with IVF or ICSI.Main Outcome MeasureCLBR per oocyte retrieval cycle.ResultsPer oocyte retrieval cycle, CLBR was significantly higher with GnRH antagonist versus PPOS (35.3% vs 25.2%; P<0.001). In multivariable logistic regression analysis, CLBR per oocyte retrieval cycle was significantly lower with PPOS versus GnRH antagonist before (OR 0.62 [95% confidence intervals (CI): 0.46, 0.82; P=0.009]) and after (OR 0.66 [95% CI: 0.47, 0.93; P=0.0172]) adjustment for age, body mass index, infertility type, infertility duration, baseline follicle stimulating hormone, anti-Müllerian hormone (AMH), antral follicle count (AFC), and insemination method. CLBR was numerically higher with the GnRH antagonist regimen than with PPOS, across all of the POSEIDON groups, and was significantly higher in patients aged ≥35 years with poor ovarian reserve [AFC <5, AMH <1.2 ng/mL] (unadjusted, P=0.0108; adjusted, P=0.0243).ConclusionIn this single-center, retrospective, cohort study, patients had a higher CLBR with a GnRH antagonist versus PPOS regimen, regardless of other attributes.
Highlights
Poor ovarian response (POR) affects between 9% and 24% [1, 2] of women undergoing assisted reproduction and is characterized by a failure to respond adequately to standard protocols and to recruit adequate follicles, resulting in reduced oocyte production and a diminished probability of pregnancy [3]
In multivariable logistic regression analysis, cumulative live birth rate (CLBR) per oocyte retrieval cycle was significantly lower with progestin-primed ovarian stimulation (PPOS) versus gonadotropin-releasing hormone (GnRH) antagonist before (OR 0.62 [95% confidence intervals (CI): 0.46, 0.82; P=0.009]) and after adjustment for age, body mass index, infertility type, infertility duration, baseline follicle stimulating hormone, anti-Müllerian hormone (AMH), antral follicle count (AFC), and insemination method
CLBR was numerically higher with the GnRH antagonist regimen than with PPOS, across all of the POSEIDON groups, and was significantly higher in patients aged ≥35 years with poor ovarian reserve [AFC
Summary
Poor ovarian response (POR) affects between 9% and 24% [1, 2] of women undergoing assisted reproduction and is characterized by a failure to respond adequately to standard protocols and to recruit adequate follicles, resulting in reduced oocyte production and a diminished probability of pregnancy [3]. The introduction of the Bologna criteria [5] in 2011 attempted to standardize the definition of POR, subsequent research suggested a number of critical issues that prevented widespread acceptance [6, 7], including a lack of adequate patient stratification [8]. Patients undergoing assisted reproduction, who have expected or unexpected impaired ovarian response can be stratified into four clear and distinct subgroups [12, 13], aiding both clinicians and researchers to formulate more optimal management plans
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