Abstract
ObjectiveTo investigate the factors that influence luteal phase short-acting gonadotropin-releasing hormone agonist (GnRH-a) long protocol and GnRH-antagonist (GnRH-ant) protocol on pregnancy outcome and quantify the influence. About the statistical analysis, it is not correct for the number of gravidities.MethodsInfertile patients (n = 4,631) with fresh in-vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) and embryo transfer were divided into GnRH-a long protocol (n =3,104) and GnRH-ant (n =1,527) protocol groups and subgroups G1 (EMT ≤7mm), G2 (7 mm <EMT ≤10 mm), and G3 (EMT >10 mm) according to EMT on the trigger day. The data were analyzed.ResultsThe GnRH-ant and the GnRH-a long protocols had comparable clinical outcomes in the clinical pregnancy, live birth, and miscarriage rate after propensity score matching. In the medium endometrial thickness of 7–10 mm, the clinical pregnancy rate (61.81 vs 55.58%, P < 0.05) and miscarriage rate (19.43 vs 12.83%, P < 0.05) of the GnRH-ant regime were significantly higher than those of the GnRH-a regime. The EMT threshold for clinical pregnancy rate in the GnRH-ant group was 12 mm, with the maximal clinical pregnancy rate of less than 75% and the maximal live birth rate of 70%. In the GnRH-a long protocol, the optimal range of EMT was >10 mm for the clinical pregnancy rate and >9.5 mm for the live birth rate for favorable clinical outcomes, and the clinical pregnancy and live birth rates increased linearly with increase of EMT. In the GnRH-ant protocol, the EMT thresholds were 9–6 mm for the clinical pregnancy rate and 9.5–15.5 mm for the live birth rate.ConclusionsThe GnRH-ant protocol has better clinical pregnancy outcomes when the endometrial thickness is in the medium thickness range of 7–10 mm. The optimal threshold interval for better clinical pregnancy outcomes of the GnRH-ant protocol is significantly narrower than that of the GnRH-a protocol. When the endometrial thickness exceeds 12 mm, the clinical pregnancy rate and live birth rate of the GnRH-ant protocol show a significant downward trend, probably indicating some negative effects of GnRH-ant on the endometrial receptivity to cause a decrease of the clinical pregnancy rate and live birth rate if the endometrial thickness exceeds 12 mm.
Highlights
In the controlled ovarian stimulation (COS) process, the gonadotropin-releasing hormone antagonist (GnRH-ant) protocol plays an increasingly important role compared with the classic protocol, the luteal phase short-acting gonadotropinreleasing hormone agonist (GnRH-a) long protocol because of the advantages of the GnRH-ant protocol which are more in line with the physiological processes
A total of 4m631 patients met the inclusion criteria and were divided into the GnRH-a long (n = 3104) and GnRH-ant (n = 1527) protocol groups according to the ovulation induction protocol. 2,824 patients were screened after 1:1 propensity score matching according to age, BMI, infertility duration, and number of gravidities (Figure 2) and were assigned to two treatment groups with 1,412 patients in each group
After propensity score matching with age, infertility duration, number of gravidities, and BMI, the significant differences between two groups were in bFSH, bE2, basic serum luteinizing hormone level (bAMH), total dose of Gn, Endometrial thickness (EMT) on the trigger day, and number of embryos transferred (Table 2)
Summary
In the controlled ovarian stimulation (COS) process, the gonadotropin-releasing hormone antagonist (GnRH-ant) protocol plays an increasingly important role compared with the classic protocol, the luteal phase short-acting gonadotropinreleasing hormone agonist (GnRH-a) long protocol because of the advantages of the GnRH-ant protocol which are more in line with the physiological processes. After comparing the clinical outcomes in GnRH-ant and GnRH-a treatment for ovulation and the pregnancy outcomes of subsequent frozen– thawed embryo transfer, Bahceci et al [4] found that the implantation rate in the fresh embryo transfer cycle was lower in the GnRH-ant than that in the GnRH-a long protocol group, but the implantation rate and clinical pregnancy rate did not decrease in subsequent frozen–thawed cycles. This may indicate that the use of GnRH-ant may adversely affect the endometrial receptivity but does not affect oocyte quality and embryo development. In this retrospective cohort study, patients who had undergone fresh in-vitro fertilization (IVF)/ intracytoplasmic sperm injection (ICSI) embryo transfer at our hospital were investigated, and the clinical pregnancy outcomes and the relationship between EMT on the trigger day and clinical outcomes in GnRH-a long and GnRH-ant protocols were analyzed to find the optimal EMT
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