GnRH agonist long protocol versus GnRH antagonist protocol for various aged patients with diminished ovarian reserve: A retrospective study

Abstract

This retrospective analysis compared the efficiency of the gonadotropin- releasing hormone (GnRH) antagonist (GnRH-ant) protocol and the GnRH agonist long (GnRH-a) protocol for patients with diminished ovarian reserve (DOR). A total of 1,233 patients with DOR (anti-Mullerian hormone <1.1 ng/mL) were recruited for this retrospective case-control study. They were divided into two groups according to female age. Younger patients were assigned to POSEIDON group3 (PG3: age ≤35 years); older patients were assigned to POSEIDON group 4 (PG4: age >35 years). All patients with DOR underwent controlled ovarian stimulation and fresh embryo transfer (ET) on day 3. We recruited 283 GnRH-a and 54 GnRH-ant cycles for PG3, and 663 GnRH-a and 233 GnRH-ant cycles for PG4. In PG3, the GnRH-a protocol was associated with a lower ET cancellation rate (30/283 = 10.2% vs. 12/54 = 22.2%, p = 0.018) and a higher live birth rate (7/54 = 13.0% vs. 78/283 = 27.6%, p = 0.024) than the GnRH-ant protocol for the initiated cycles. Furthermore, the GnRH-a protocol was correlated with a higher implantation rate than the GnRH-ant protocol for ET cycles (146/577 = 25.3% vs. 11/103 = 10.7%, P = 0.027). No differences in the ET cancellation rate, live birth rate and implantation rate between GnRH-a and GnRH-ant groups were observed among PG4 patients. In conclusion, the GnRH-a protocol was more effective than the GnRH-ant protocol for young patients with DOR. The low ET cancellation rate and high implantation rate may be related to embryo quality or endometrial receptivity, which warrant further investigation.

Long-Acting GnRH Agonist Improves IVF Outcomes of Young Patients with Diminished Ovarian Reserve by Increasing Endometrial Receptivity.

“…Long-acting GnRH agonist may result in excessive ovarian suppression. Therefore, the conventional ovarian stimulation protocols are mainly mild ovarian stimulation and GnRH antagonist protocols for DOR patients [7,8,10,13]. However, in our present study, our data indicate that long-acting GnRH agonist could improve endometrial thickness and clinical outcomes of IVF for young DOR patients.…”

“…To attempt to optimize in vitro fertilization (IVF) outcomes for DOR, a lot of treatments have been proposed, such as different ovarian stimulation protocols, luteal phase pretreatments and various supplements and modi cations during ovarian stimulation [7][8][9][10][11]. However, most of the therapeutic strategies had limited success.…”

“…Therefore, it is crucial to select an optimized ovarian stimulation protocol for patients with DOR. But, it is very di cult for such patients, since few oocytes are retrieved in a single ovarian stimulation cycle [8,11]. Considering the few antral follicle count (AFC) of DOR patients, the conventional ovarian stimulation protocols are mainly mild ovarian stimulation and gonadotrophin-releasing hormone (GnRH) antagonist protocols [7,8,10,13].…”

What Is the Best Regimen for Ovarian Stimulation of Poor Responders in ART/IVF?

“…• GnRH analogues (3,25,26) • Androgens (25) • GH cotreatment (25,27) • Natural cycle or modified natural cycle (25) • High dose gonadotropins (25) • Glucocorticoids 3• Coenzyme Q10 (28) • Acupuncture (29) • Holistic medicine (25) • Autologous Platelet-Rich Plasma • In-vitro activation of follicles • Combination of the above (25).…”

“…Huang et al have recently compared the efficiency of the GnRHa vs GnRH antagonist protocols in 1233 POR patients (26). They have found a lower cancellation rate (10 vs. 22%), higher implantation rate (25.3 vs. 10.7%), and higher LBR (27.6 vs. 13%) in young POR patients (POSEIDON group 3), but not in the older POR patients (POSEIDON group 4), undergoing the GnRH agonist COS protocol than in those using the antagonist protocol (26). They concluded that the agonist protocol was more effective than the antagonist protocol for young POR patients (26).…”