Comparison of cumulative live birth rates per oocyte retrieval cycle in patients with normal ovarian reserve function treated with PPOS and GnRH agonist long protocol
10.3760/cma.j.cn101441-20230614-00237
- VernacularTitle:卵巢储备功能正常患者应用PPOS与激动剂长方案的每取卵周期累积活产率比较
- Author:
Hong CHEN
1
;
Guohua LI
;
Yuanyuan WU
;
Wenpei SHI
;
Miaoxin CHEN
;
Xiaoming TENG
;
Yan XIA
;
Zhiqin CHEN
Author Information
1. 同济大学附属上海市第一妇婴保健院生殖医学科，上海 201204
- Publication Type:Journal Article
- Keywords:
Fertilization in vitro;
Embryo transfer;
Progestin-primed ovarian stimulation;
Gonadotropin-releasing hormone agonist long protocol;
Cumulative live
- From:
Chinese Journal of Reproduction and Contraception
2024;44(3):237-248
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To compare the cumulative live birth rates per oocyte retrieval cycle in patients with normal ovarian response between the gonadotropin-releasing hormone agonist (GnRH-a) long protocol and the progestin-primed ovarian stimulation (PPOS) protocol.Methods:A retrospective cohort study was conducted in Centre of Assisted Reproduction, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine between January 2017 and December 2019. Women who underwent in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatment with normal ovarian reserve and <40 years of age were included. Other inclusion criteria included regular menstrual cycles, serum follicle-stimulating hormone level <10 U/L, and the antral follicle count >5. The primary outcome was the cumulative live birth rate (CLBR) within 18 months from the start of ovarian stimulation. Results:A total of 995 patients were included in the study, with 509 patients in the PPOS group and 486 patients in the GnRH-a long group. Both groups had almost comparable demographic and cycle stimulation characteristics except for duration of infertility which was shorter in the PPOS group [3 (2,4) years] than in the GnRH-a long group [3 (2,5) years, P=0.015]. In the GnRH-a long group, 372 patients (77%) underwent fresh embryo transfer, resulting in 218 clinical pregnancies and 197 live births. The clinical pregnancy rate, the ongoing pregnancy rate, and the live birth rate per embryo transfer cycle were 58.6% (218/372), 54.0% (201/372) and 53.0% (197/372), respectively. No fresh embryo transfer was performed in the PPOS group. During the study period, there were 662 frozen-thawed embryo transfer (FET) cycles in the PPOS group and 257 FET cycles in the GnRH-a long group. The PPOS group had a live birth rate of 31.1% (206/662) per FET cycle, which was notably lower than the GnRH-a long group [42.8% (110/257), OR=0.727; 95% CI: 0.607-0.871; P<0.001]. The implantation rate of all FET cycles in the PPOS group was also lower than that in the GnRH-a long group [29.2% (293/1 004) vs. 34.5% (157/455), OR=0.846, 95% CI: 0.721-0.992; P=0.041]. CLBRs after one complete IVF/ICSI cycle including fresh and subsequent FET cycles within 18 months follow up were significantly lower in the PPOS group [40.5% (206/509)] than in the long agonist group [63.2% (307/486), OR=0.641, 95% CI: 0.565-0.726]. Compared with the PPOS group, the GnRH-a long group had a significantly shorter duration from the start of ovarian stimulation to pregnancy and live birth ( P<0.001). In Kaplan-Meier analysis, the CLBR was significantly higher in the GnRH-a long group than in the PPOS group (long rank test, P<0.001). Adjusted Cox-regression analysis revealed stimulation protocol adopted was strongly associated with the CLBR ( OR=1.917, 95% CI: 1.152-3.190, P=0.012). Conclusion:Progestin primed ovarian stimulation was associated with a lower cumulative live birth rates and a long time to pregnancy/live birth than the long agonist protocol in women with a normal ovarian reserve.
