The use of GnRH agonist long protocol in women with advanced age has the efficient clinical outcome than that of GnRH antagonist short protocol in IVF cycles

Abstract

OBJECTIVE: To assess and compare the clinical outcome between gonadotropin releasing hormone (GnRH) agonist long protocol and GnRH antagonist short protocol in IVF cycles.DESIGN: Retrospective data analysis.MATERIALS AND METHODS: The study included 781 cycles between January 2006 and December 2007 in IVF cycles, controlled ovarian hyperstimulation were performed with GnRH agonist long protocol and GnRH antagonist short protocol. In 281 cycles (219 patients), 0.25mg daily of a GnRH antagonist (Cetrotide, Serono, Switzerland) was used when a leading follicle was 14 mm in diameter, until the day that human chorionic gonadotropin (hCG) was administered. In 500 cycles (382 patients), the classical long protocol with a GnRH agonist (Lucrin, Abbott, France) was used. Outcomes were compared patients age, the number of retrieved oocytes, transferred embryos and clinical pregnancy between the two groups. Subgroup was classify according to age (<40 years old or ≥40 years old). These data were statistically analyzed by t-test. P value <0.05 was considered statistically significant.RESULTS: The mean age of all patients (34.1 ± 4.0 vs. 34.6 ± 4.1), the number of transferred embryos (4.1 ± 1.2 vs. 3.9 ± 1.2) and clinical pregnancy rate (51.6% vs. 46.6%) between GnRH agonist long protocol and GnRH antagonist short protocol were no significant differences. Although the number of retrieved oocytes (13.5 ± 8.4 vs. 11.9 ± 7.7 respectively; P<0.05) had a statistically significant difference in both groups, the clinical pregnancy rate showed no difference. In patients age <40 years old, no significant outcome difference were found (53.9% vs. 50.8%). However, in patients age ≥40 years old, GnRH agonist long protocol showed a nearly doubled pregnancy rate than GnRH antagonist short protocol and this results were statistically significant without a numerical difference of retrieved oocytes (30.6% vs. 17.1% respectively; P<0.05).CONCLUSIONS: Our data indicates that GnRH agonist long protocol appears to be slightly more effective than the GnRH antagonist short protocol in clinical pregnancy rate but shows statistically no significant difference. However, in patients age ≥40 years old, the use of GnRH agonist long protocol was significantly higher clinical pregnancy rate than GnRH antagonist short protocol. The use of the GnRH agonist long protocol in comparison with that of the GnRH antagonist short protocol in women with advanced age seems to result in significantly better efficiency in IVF outcome. OBJECTIVE: To assess and compare the clinical outcome between gonadotropin releasing hormone (GnRH) agonist long protocol and GnRH antagonist short protocol in IVF cycles. DESIGN: Retrospective data analysis. MATERIALS AND METHODS: The study included 781 cycles between January 2006 and December 2007 in IVF cycles, controlled ovarian hyperstimulation were performed with GnRH agonist long protocol and GnRH antagonist short protocol. In 281 cycles (219 patients), 0.25mg daily of a GnRH antagonist (Cetrotide, Serono, Switzerland) was used when a leading follicle was 14 mm in diameter, until the day that human chorionic gonadotropin (hCG) was administered. In 500 cycles (382 patients), the classical long protocol with a GnRH agonist (Lucrin, Abbott, France) was used. Outcomes were compared patients age, the number of retrieved oocytes, transferred embryos and clinical pregnancy between the two groups. Subgroup was classify according to age (<40 years old or ≥40 years old). These data were statistically analyzed by t-test. P value <0.05 was considered statistically significant. RESULTS: The mean age of all patients (34.1 ± 4.0 vs. 34.6 ± 4.1), the number of transferred embryos (4.1 ± 1.2 vs. 3.9 ± 1.2) and clinical pregnancy rate (51.6% vs. 46.6%) between GnRH agonist long protocol and GnRH antagonist short protocol were no significant differences. Although the number of retrieved oocytes (13.5 ± 8.4 vs. 11.9 ± 7.7 respectively; P<0.05) had a statistically significant difference in both groups, the clinical pregnancy rate showed no difference. In patients age <40 years old, no significant outcome difference were found (53.9% vs. 50.8%). However, in patients age ≥40 years old, GnRH agonist long protocol showed a nearly doubled pregnancy rate than GnRH antagonist short protocol and this results were statistically significant without a numerical difference of retrieved oocytes (30.6% vs. 17.1% respectively; P<0.05). CONCLUSIONS: Our data indicates that GnRH agonist long protocol appears to be slightly more effective than the GnRH antagonist short protocol in clinical pregnancy rate but shows statistically no significant difference. However, in patients age ≥40 years old, the use of GnRH agonist long protocol was significantly higher clinical pregnancy rate than GnRH antagonist short protocol. The use of the GnRH agonist long protocol in comparison with that of the GnRH antagonist short protocol in women with advanced age seems to result in significantly better efficiency in IVF outcome.