FOLLICULAR-PHASE SINGLE-DOSE GnRH AGONIST PROTOCOL VS GnRH ANTAGONIST PROTOCOL IN PATIENTS WITH REPEATED IVF FAILURE

Abstract

To compare the clinical outcomes between follicular-phase single-dose gonadotropin-releasing hormone (GnRH) agonist protocol and GnRH antagonist protocol in patients with repeated IVF failure. Retrospective analysis. The IVF cycles conducted on 764 patients with repeated IVF failure (No. of previous failed IVF cycle>=2) and normal ovarian reserve (AMH >1.1ng/ml) from Jun. 2017 to Dec. 2019 were included in this retrospective cohort study. The follicular-phase single-dose GnRH agonist protocol, in which 3.75 mg Triptorelin was administrated on cycle day 2 and exogenous gonadotropin (Gn) was initiated 4 weeks later, was applied in 303 patients and GnRH antagonist protocol utilized in the remaining 461 patients. The clinical outcomes, including stimulation duration, total dose of exogenous Gn, No. of oocytes retrieved, No. of transferrable embryos, clinical pregnancy rate and miscarriage rate between the two groups were compared respectively. P<0.05 was considered as statistical significance. No significant difference was observed in basic characteristics between two groups. Comparing with the antagonist group, both the stimulation duration and the total Gn dose were significantly longer and higher in the agonist group. More oocytes and transferrable embryos were obtained, and the clinical pregnancy rate per fresh embryo transfer cycle was significantly higher in the agonist group. The basic and cycle characteristics were listed in the following table.Tabled 1GnRH agonist protocol (n=303)GnRH antagonist protocol (n=461)P valueAge (y)33.61±3.5833.95±3.940.231BMI (Kg/m2)22.20±5.4922.03±2.940.186Infertility duration (y)5.67±3.265.36±3.310.209AMH (ng/ml)3.29±2.083.39±3.181.000No. of previous IVF cycles2.62±1.042.62±1.330.952Gn initiation dose (IU)235.07±58.80229.00±59.360.164Stimulation duration (d)11.02±1.858.49±1.45<0.01Dose of Gn (IU)2633.45±783.821937.08±586.31<0.01No. of oocytes retrieved12.12±5.959.79±6.44<0.01No. of transferrable embryos4.24±3.503.57±3.23<0.01No. of good-quality embryos3.30±3.122.82±2.960.03No. of embryos transferred1.79±0.511.84±0.44<0.01No. of cycles with fresh embryo transfer181197Clinical pregnancy rate (%)53.6034.01<0.01Miscarriage rate (%)20.6214.930.354 Open table in a new tab In patients with repeated IVF failure, follicular-phase single-dose GnRH agonist protocol resulted in a significantly higher clinical pregnancy rate than antagonist treatment, implying that single-dose GnRH agonist treatment may offer additional benefits for this specific group of patients.