Comparison of different ovarian hyperstimulation protocols efficacy in poor ovarian responders classified by Poseidon criteria
10.3760/cma.j.cn101441-20200421-00236
- VernacularTitle:波塞冬分类标准下的不同卵巢刺激方案对卵巢低反应患者的疗效分析
- Author:
Fei LI
1
;
Aiqin NIU
;
Jianbing FENG
;
Chenchen WANG
;
Xingmei FENG
;
Yali ZHANG
;
Ying CHEN
Author Information
1. 商丘市第一人民医院生殖医学中心 470000
- Publication Type:Journal Article
- Keywords:
Poseidon criteria;
Poor ovarian response;
Controlled ovarian stimulation;
Fertilization in vitro;
Live birth
- From:
Chinese Journal of Reproduction and Contraception
2021;41(9):770-775
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To compare the efficiency of the early-follicular phase long-acting gonadotropin-releasing hormone agonist (GnRH-a) long protocol, the mid-luteal phase short-acting GnRH-a long protocol and the gonadotropin-releasing hormone antagonist (GnRH-A) protocol in poor ovarian responders classified by Poseidon criteria, and to explore the most appropriate and effective ovarian hyperstimulation protocol in each Poseidon criteria.Methods:The clinical data from poor ovarian responders according to the Poseidon criteria who underwent in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) in the Reproductive Medicine Center of the First Clinical College of Zhengzhou University were retrospectively analyzed by a cohort study. The patients were further divided into lower age group (<35 years) and high age group (≥35 years). The data of baseline characteristics and clinical outcomes in each ovarian hyperstimulation protocol group were analyzed and compared. Results:Totally 1249 eligible subjects were recruited in the study, including 410 patients in lower age group and 839 patients in high age group. In lower age group, early-follicular phase long-acting GnRH-a long protocol was associated with higher oocyte number (5.6±3.6 vs. 4.6±3.2 vs. 2.4±1.7, P<0.001) and No. of transferable embryos (2.2±1.6 vs. 1.6±1.6 vs. 1.1±1.1, P<0.001), lower cancellation rate of embryo transfer [20.8% (33/159) vs. 39.5% (49/124) vs. 69.3% (88/127), P<0.001], higher pregnancy rate per transfer [40.9% (65/159) vs. 29.0% (36/124) vs. 15.7% (20/127), P<0.001], and higher live birth rate [31.4% (50/159) vs. 23.4% (29/124) vs. 12.6% (16/127), P<0.001] than mid-luteal phase short-acting GnRH-a long protocol and GnRH-A protocol. However, there was no significant difference in implantation rate and abortion rate among three protocols ( P>0.05). In high age group, the early-follicular phase long-acting GnRH-a long protocol was associated with higher oocyte number (3.9±2.8 vs. 3.1±2.3 vs. 2.5±1.8, P<0.001) and No. of transferable embryos (2.8±2.0 vs. 2.4±2.0 vs. 2.1±1.7, P<0.001), lower cancellation rate of embryo transfer [19.5% (60/307) vs. 28.7% (102/355) vs. 53.3% (56/105), P<0.001] than mid-luteal phase short-acting GnRH-a long protocol and GnRH-A protocol. However, there was no statistical significance in implantation rate, pregnancy rate, abortion rate and live birth rate among the three protocols ( P>0.05). Conclusion:It seems that the early-follicular phase long-acting GnRH-a long protocol was more effective in clinical outcomes than the mid-luteal phase short-acting GnRH-a long protocol and the GnRH-A protocol for young patients with POR. It is worth emphasizing that the older the patient is, the lower the live birth rate will be. The characteristics and prognosis of patients should be used to develop clinical management strategies especially for the POR crowd.
