Live birth rate comparison of three controlled ovarian stimulation protocols for in vitro fertilization-embryo transfer in patients with diminished ovarian reserve after endometrioma cystectomy: a retrospective study

Abstract

Background: Women with endometriosis and previous cystectomy may respond less well to gonadotropin stimulation, which results in fewer oocytes retrieved and poor pregnancy outcomes. Choosing an appropriate protocol for such populations is essential. This study involved an analysis of the effect of different controlled ovarian stimulation (COS) protocols on the clinical outcomes of in vitro fertilization-embryo transfer (IVF-ET) in women with diminished ovarian reserve (DOR) who underwent ovarian endometrioma cystectomy. Methods: A total of 342 patients that underwent IVF-ET treatment at the Beijing Obstetrics and Gynecology Hospital from January 1, 2013 to April 30, 2018 were included in this retrospective study. The patients were distributed into three groups according to the COS protocols, namely prolonged GnRH-agonist (Group A, n = 113), GnRH-antagonist (Group B, n = 121), and long GnRH-agonist (Group C, n = 108). The clinical and laboratory parameters of the three protocols were analyzed and a logistic regression of clinical pregnancy and live births was conducted. Results: There were no significant differences in the age, infertility duration, basic follicle stimulation hormone (FSH), luteinizing hormone (LH), or estradiol (E 2 ) levels as well as other baseline characteristics among groups (P > 0.05). The total gonadotrophin (Gn) dosage and duration tended to be less in the GnRH-antagonist group than in the others (P < 0.05). No significant differences were found in the implantation rate and clinical pregnancy rate among the groups, but the prolonged GnRH-agonist group showed the highest rates. In addition, no significant differences were present in the number of retrieved oocytes, oocyte fertilization rate, embryo utilization rate, live birth rate, abortion rate, ectopic pregnancy rate, or multiple pregnancy rate in the three groups (P > 0.05). Age had a significant effect on both clinical pregnancy and live birth. Conclusion:For those DOR patients who had undergone ovarian endometriosis cystectomy, the prolonged GnRHagonist protocol may achieve better clinical IVF-ET outcomes, but there were no significant differences from the other groups. The GnRH-antagonist protocol may reduce the cost and time of drug treatment. Age should be considered for its influence on pregnancy outcome. However, a larger sample size may be needed for further study.

Study of patients with diminished ovarian reserve and our approach to their treatment: retrospective analytic study

“…Also, these pregnancies were likely to be healthier reflected by lower abortion rate (28% vs 34% in antagonist cycles). 21 Similarly, in our study cohort we found a beta HCG positive rate (Implantation Rate) 33 % for agonist cycle as compared to 25% for antagonist cycle. Although we had no cycle cancellation, agonist protocol is likely to have more cycle cancellation as compared to antagonist cycle.…”

Clinical pregnancy outcomes prediction in vitro fertilization women based on random forest prediction model: A nested case-control study

“…Pregnancies were diagnosed according to the serum B-hCG levels 14 days after embryo transfer and the clinical pregnancy was confirmed by visualization of a gestational sac on ultrasonographic examination 28 to 35 days after the embryo transfer. [ 13 ] The biochemical pregnancy was defined as the serum β-HCG > 25U/L 14 days after embryo transfer. Live birth was considered when a living fetus was born after 28 weeks of pregnancy.…”

A Modified ICSI Technique: Using Zona Pellucida as A Natural Bait

“…We followed the routine ovarian hyperstimulation [18] and all female patients were injected daily at a fixed time with a subcutaneous follicle-stimulating hormone (Gn, Gonal-F, Merck Serono, USA) from the 3rd to the 5th day of the menstrual cycle.…”