Evaluation of the clinical effects of antagonist protocol and progestin-primed ovarian stimulation protocol in patients with low prognosis according to POSEIDON criteria by cumulative live birth rate per oocyte extraction cycle: a retrospective cohort study
10.3760/cma.j.cn101441-20200519-00291
- VernacularTitle:以每取卵周期累积活产率评价拮抗剂方案与PPOS方案在波塞冬标准低预后患者的临床效果：一项回顾性队列研究
- Author:
Shaodi ZHANG
1
;
Yisha YIN
1
;
Qiuyuan LI
1
;
Cuilian ZHANG
1
Author Information
1. 河南省人民医院（河南大学人民医院）生殖医学中心，郑州450003
- Publication Type:Journal Article
- Keywords:
Fertilization in vitro;
Embryo transfer;
Cumulative live birth rate;
POSEIDON standard
- From:
Chinese Journal of Reproduction and Contraception
2022;42(1):9-16
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the clinical effects of antagonist protocol and progestin-primed ovarian stimulation (PPOS) protocol in patients with low prognosis.Methods:A total of 1560 controlled ovarian stimulation cycles of 1419 patients consistent with POSEIDON low prognosis with antagonist protocol or PPOS protocol in the treatment of in vitro fertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET) from January 2016 to December 2018 in the Reproductive Medicine Center of Henan Provincial People's Hospital were collected in a retrospective cohort study. The essential characteristic, clinical characteristics, laboratory index and clinical outcomes of patients in the antagonist protocol group and the PPOS protocol group were compared. Multivariate logistic regression analysis was used to compare cumulative live rate per ovulation cycle after adjusting for confounders of the two controlled ovarian stimulation protocols. Results:The comparison of the general conditions of the patients with the two controlled ovarian stimulation protocols showed that anti-Müllerian hormone (AMH) [1.45(0.68, 3.28) μg/L] and antral follicle count (AFC) [7.00(4.00,11.00) μg/L] in the antagonist protocol group were significantly higher than those in the PPOS protocol group [1.10(0.55, 2.71) μg/L, P=0.002; 6.00(3.00, 9.00) μg/L, P=0.010], and basal follicle-stimulating hormone (FSH) [7.65(6.26, 9.99) U/L] was significantly lower than that in the PPOS protocol group [7.88(6.29, 10.58) U/L, P=0.007]. The results of laboratory and clinical outcomes showed that the estrogen level [726.20(415.30,1 095.00) ng/L] on human chorionic hormone (hCG) injection day in the antagonist protocol group was significantly lower than that in the PPOS protocol group [738.00(412.55, 1 187.75) ng/L, P=0.028], and the endometrial thickness [(9.31±2.67) mm] on hCG injection day, the cumulative pregnancy rate [49.35% (379/768)] and the cumulative live birth rate per ovulation cycle [38.04% (291/765)] were significantly higher than those in the PPOS protocol group [(6.81±2.26) mm, P<0.001; 37.62% (298/792), P<0.001; 26.08% (206/790), P<0.001]. After adjusting for confounder factors, the cumulative pregnancy rate ( OR=1.58, 95% CI=1.24-2.01, P<0.001) and the cumulative live birth rate ( OR=1.68, 95% CI=1.30-2.17, P<0.001) per ovulation cycle in the antagonist protocol group were higher than those in the PPOS protocol group in patients with POSEIDON low prognosis. The results of stratified analysis showed that the cumulative pregnancy rate and the cumulative live birth rate per ovulation cycle of antagonist protocol group per ovulation cycle was higher than that of PPOS protocol group. The cumulative pregnancy rate and the cumulative live birth rate per ovulation cycle in different age ( P<0.001, P<0.001), insemination method ( P<0.001, P<0.001), AMH ( P<0.001, P<0.001) and POSEIDON group 1 ( P=0.001, P<0.001) and POSEIDON group 3 ( P=0.008, P=0.024) were statistically different. Conclusion:In patients with low prognosis of POSEIDON, the antagonist protocol improved the cumulative live birth rate per ovulation cycle compared with the PPOS protocol, especially for patients in POSEIDON group 1 and POSEIDON group 3.
