Comparison of clinical and perinatal outcomes of different gonadotropin starting dosages in the early-follicular phase long-acting GnRH agonist long protocol in young patients with expected poor prognosis according to POSEIDON criteria
10.3760/cma.j.cn101441-20240621-00224
- VernacularTitle:波塞冬标准年轻预期低预后患者卵泡期长效长方案不同促性腺激素启动剂量的临床及围产结局比较
- Author:
Haijiao ZOU
1
;
Fang WANG
1
;
Hao SHI
1
;
Yunyun JIAO
1
;
Yuan MA
1
;
Yu LIU
1
;
Yihong GUO
1
Author Information
1. 郑州大学第一附属医院生殖医学中心，郑州 450052
- Publication Type:Journal Article
- Keywords:
Gonadotropin;
Poor ovarian response;
POSEIDON criteria;
Early-follicular phase long-acting GnRH agonist long protocol;
Perinatal outcomes
- From:
Chinese Journal of Reproduction and Contraception
2024;44(11):1121-1130
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate whether there are differences in clinical outcomes and perinatal outcomes associated with different initial dosages of gonadotropin (Gn) in expected poor prognosis young patients, diagnosed according to the POSEIDON criteria, undergoing the early-follicular phase long-acting gonadotropin-releasing hormone agonist (GnRH-a) long protocol.Methods:This retrospective cohort study analyzed clinical data from patients who underwent their first in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI)-fresh embryo transfer (ET) cycle at the Reproductive Medicine Center of the First Affiliated Hospital of Zhengzhou University between January 1, 2016, and June 30, 2022. Patients included in the study were those who underwent ovarian stimulation with the early-follicular phase long-acting GnRH-a long protocol and young expected poor prognosis. Patients were divided into three groups based on the starting Gn dosage: low-dose group (Gn<225 U), medium-dose group (225 U≤Gn<300 U), and high-dose group (Gn=300 U). Clinical and perinatal outcomes were compared among the three groups. Results:A total of 1 659 cycles were included in the study, with 316 cycles in the low-dose group, 536 cycles in the medium-dose group, and 807 cycles in the high-dose group. The number of oocytes retrieved in the high-dose group [6.00 (4.00,9.00)] was less than that in the medium-dose group [8.00 (6.00,11.00)] and the low-dose group [11.00 (7.00,13.00)], which in the medium-dose group was less than that in the low-dose group, and the differences were statistically significant (all P<0.017). There were no significant statistical differences in oocyte maturation rate, normal fertilization rate of IVF/ICSI, or high-quality embryo rate among the three groups (all P>0.05). The blastocyst formation rates decreased sequentially in the low-dose group [20.33% (425/2 090)], medium-dose group [17.28% (510/2 951)], and high-dose group [14.62% (518/3 542)], with significant differences between each pair of groups (all P<0.017). There were no significant differences in clinical pregnancy rate, biochemical pregnancy rate, ectopic pregnancy rate, miscarriage rate, chromosomal abnormalities in miscarriage tissues, or preterm birth rate among the three groups (all P>0.05). However, the live birth rate was significantly lower in the high-dose group [47.83% (386/807)] than in the low-dose group [57.28% (181/316), P=0.004]. After adjusting for confounding factors using multivariate logistic regression, the high starting Gn dosage was found to be an independent risk factor for decreased live birth rate (a OR=0.659, 95% CI: 0.462-0.941, P=0.022). There were no significant differences in perinatal outcomes among the groups, regardless of whether confounding factors were adjusted for (all P>0.05). Conclusion:In young patients with expected poor prognosis undergoing their first ovarian stimulation with the long-acting follicular phase protocol, increasing the starting Gn dosage does not increase the number of oocytes retrieved and is associated with a lower blastocyst formation rate and a reduced live birth rate, but does not increase the risk of adverse perinatal outcomes.
