Abstract
ObjectiveTo compare the two GnRH-a protocols (long GnRH-a protocol and short GnRH-a protocol) for ovarian stimulation in IVF/ICSI cycles in patients of various age ranges.MethodsA total of 5662 IVF-ET/ICSI cycles from 2010 to 2013 were retrospectively identified. The cycles were divided into two groups: a long protocol group and short protocol group. In each group, the patients were divided into four age ranges: <31 years, 31 to 35 years, 36 to 40 years, and >40 years. The duration of stimulation, total dose of Gn, implantation rate and pregnancy rate were compared.ResultsThe total dose of Gn was significantly higher, and the duration of stimulation was significantly longer, in the long protocol group than in the short protocol group for all age ranges (P<0.05). If the patients were of the same age range, the number of oocytes retrieved, MII oocytes, and high-quality embryos in the long protocol group were all significantly greater than those in the short protocol group (P<0.05). In the long protocol group, the clinical pregnancy rates of the four age ranges were 52.76%, 44.33%, 36.15% and 13.33%, respectively, which were significantly higher than those in the short protocol group (33.33%, 24.58%, 22.49% and 8.72%, respectively; P<0.05). The same trend was also found in the implantation rates of the four age ranges. As the age increased, the clinical pregnancy and implantation rates, as well as the number of oocytes retrieved, MII oocytes, and high-quality embryos, of the long protocol group significantly decreased (P<0.05).ConclusionsOur study demonstrated that regardless of patient age, the long protocol was superior to the short protocol in terms of the number of retrieved oocytes, as well as the implantation and pregnancy rates.
Highlights
Controlled ovarian hyper-stimulation (COH) is a highly important component of in vitro fertilization-embryo transfer/intra-cytoplasmic sperm injection (IVF-ET/ICSI) cycles
If the patients were of the same age range, the number of oocytes retrieved, MII oocytes, and high-quality embryos in the long protocol group were all significantly greater than those in the short protocol group (P
Our study demonstrated that regardless of patient age, the long protocol was superior to the short protocol in terms of the number of retrieved oocytes, as well as the implantation and pregnancy rates
Summary
Controlled ovarian hyper-stimulation (COH) is a highly important component of in vitro fertilization-embryo transfer/intra-cytoplasmic sperm injection (IVF-ET/ICSI) cycles. Porter et al first reported that gonadotropins (Gn) with Gonadotropin-releasing hormone agonists (GnRH-a) were used for ovarian stimulation in IVF cycles [1]. Pituitary suppression was obtained by GnRH-a to prevent premature luteinization. The long GnRH-a protocol is the most popular regimen in IVF-ET/ICSI treatment, and excellent results have been obtained [2]. Because GnRH agonist can induce an initial “flare-up” effect, the short GnRH-a protocol is usually provided to poor responders to avoid excessive pituitary suppression [3]. The data in one meta-analysis reported that the long protocol was more effective than the short protocol in terms of oocyte retrieval and clinical pregnancy rates [2]. The other meta-analysis concluded that there was no difference between the short and long protocols [4]
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