Roles of gonadotropin-releasing hormone antagonist in patients with high ovarian response

Abstract

Objective To explore the clinical outcomes of in vitro fertilization/intracytoplasmic sperm injection and embryo transfer (IVF/ICSI-ET) in high responders using long gonadotropin-releasing hormone agonist (GnRH-a) protocol or GnRH antagonist (GnRH-A) protocol. Methods The retrospective analysis was performed based on 1 916 IVF-ET/ICSI cycles, including 480 cycles of GnRH-A protocol (group A) and 1 436 cycles of GnRH-a long protocol (group B), from June 2014 to September 2016. Then all cycles were divided into two groups by oocyte numbers, respectively: group A1 and group B1 (No. of oocyte <15) and groups A2 and B2 (No. of oocyte ≥15). Results No statistical differences were noticed in group A and group B in terms of starting dose, estradiol (E2) level on the day of human chorionic gonadotropin (hCG) injection, No. of retrieved oocytes, implantation rate, clinical pregnancy rate, ectopic pregnancy rate, live birth rate. Compared with group B [(1 949.33±795.72) IU, (12.4±2.4) d, 14.42%], the total gonadotropin (Gn) dosage [(1 561.89±695.38) IU] and duration [(10.8±2.6) d], ovarian hyperstimulation syndrome (OHSS) incidence (10.0%) were significantly lower in group A (P=0.00, P=0.00, P=0.01). The total Gn used dosage [(1 499.99±633.93) IU] and duration [(10.6±2.9) d], OHSS incidence (2.81%), No. of retrieved oocytes (9.8±3.2) were significantly lower in group A1 than group B1 [(2 091.19±991.81) IU, (12.6±2.8) d,7.08%, 10.4±2.9] (P=0.00, P=0.00, P=0.02, P=0.04). The implantation rate, clinical pregnancy rate and live birth rate were significantly higher in group A1 than group B1, but no statistical difference was noticed (P>0.05). The total Gn used dosage [(1 598.62±727.94) IU] and duration [(10.9±2.5) d] were significantly lower in group A2 than group B2 [(1 886.82±683.2) IU, (12.4±2.1) d] (P=0.00, P=0.00). OHSS incidence, implantation rate, clinical pregnancy rate and live birth ate between group A1 and group B1 showed no statistical differences (P>0.05). Conclusion GnRH-A protocol can reduce Gn used dosage and control the OHSS rate of high responders, which can be used in patients with OHSS risk as the first choice. Key words: Gonadotropin-releasing hormone antagonist (GnRH-a) protocol; GnRH agonist long protocol; High responder; Cinical outcomes; Ovarian hyperstimulation syndrome (OHSS)