Mild stimulation versus antagonist protocol in patients ≥43years old undergoing intracytoplasmic sperm injection

Abstract

To determine whether the mild stimulation(MS) or the antagonist protocol(AP) works better in patients ≥43 years old undergoing ICSI. Retrospective review. From January 2005 to January 2012, 1047 women ≥43 years of age had ICSI therapy performed using either MS (n=201) or AP (n=846) in our unit. Primary end-points were implantation rate(IR) and clinical pregnancy rates. Data was analyzed using Student's t-test and Chi-square as appropriate on an intention to treat basis. The two groups had similar demographic characteristics. The number of retrieved oocytes, MII oocytes, 2PN embryos and the number of transferred embryos were significantly lower in MS group(p<0.0001). The mean duration of stimulation and E2 level on hCG day was significantly higher in AP(p<0.0001). The endometrial thickness on hCG day was significantly thicker in AP (p<0.0001).Total dose of gonadotropins required for stimulation was significantly higher in AP (p<0.0001). The cancellation rate was significantly higher in MS group(p=0.0043). Clinical pregnancy rates and ongoing pregnancy rates were significantly lower in MS (p=0.0253 and p=0.0286)respectively. IR and live-birth rates were similar between two groups.Table 1Comparion of two groupsAntagonist(N=846)Mild stimulation(N=201)pAge44.42±1,5444.51±1.610.4605BMI27.08±4,3027.03±4.360.8825E2 on hCG day1544.00±801.49616.64±402.29<0.0001Endometrial thickness on hCG day11.05±3.117.85±2.44<0.0001Total dose of gonadotropin3090.21±1579.021525.17±1006.51<0.0001Total duration of stimulation7.96±2.135.32±2.52<0.0001Number of oocytes retrieved4.42±4.442.40±1.88<0.0001M23.40±3.371.93±1.37<0.00012PN3.02±2.791.64±1.30<0.0001ET #1.81±0.841.51±0.89<0.0001IR(%)6.673.530.1254Cancellation rate(%)25.0535.320.0043CPR/ET(%)11.674.610.0253OPR/ET(%)6.150.760.0286LBR/ET(%)4.100.760.1068Miscarriage/ET(%)10.096.920.3262 Open table in a new tab This study demonstrates that the use of antagonist protocol provides better ART outcomes than MS in women≥ 43 years.