ABSTRACT
Background: The high prevalence of infertility has made it a major healthcare problem in the present era. A majority of patients presenting with infertility have poor ovarian reserve (POR). Patients with POR are challenging to treat due to reduced treatment success and high cycle cancellation rate as there is no uniform definition and treatment protocol for these patients. The present retrospective study was performed to compare the pregnancy outcome between a long agonist protocol and flexible antagonist protocol in patients with POR. Patients with AMH ≤1.5 ng/mL and AFC ≤4 was included in the study. Controlled ovarian hyperstimulation is the basis of any in vitro fertilisation (IVF) procedure. There is no universally accepted ideal stimulation protocol for patients with POR, and it remains a challenge.Methods: This was a retrospective study covering the period from May 2019 to March 2020. Ninety-nine patients with low ovarian reserve (AMH ≤1.5 ng/mL and AFC ≤4) were included in the study. The patients underwent GnRH agonist/GnRH antagonist stimulation protocol using recombinant FSH. Demographic characteristics like age, BMI, duration of infertility was comparable. Total days of stimulation, total Gonadotropin dose used and clinical pregnancy rate in both the protocols was analyzed. Difference between the two groups was considered statistically significant at p-value <0.05.Results: Fifty-three patients underwent antagonist stimulation protocol and forty-six long agonist protocol. The clinical pregnancy rate was 37.7% (20/53) and 32.6% (15/46) in antagonist and agonist protocol respectively (p-value=0.5983). Pregnancy rate was higher in the antagonist group but the difference was not statistically significant.Conclusions: Antagonist protocol could marginally increase pregnancy rate in patients with low ovarian reserve. However, patients with poor ovarian reserve require a tailor-made protocol.
ABSTRACT
Objective To compare the outcomes in pregnancy between the patients with poor ovarian reservation receiving ultra-long-term down-regulation protocol and modified long-term protocol who were undergoing in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI),aiming at screening an optimal ovulation induction scheme.Methods Retrospectively analyzed the clinical data of 78 patients with poor ovarian reservation who underwent IVF or ICSI from October 2010 to July 2012.Forty-three patients received modified long-term protocol treatment (group A),with 0.375 mg long-acting triptorelin during the midluteal phase as well as superovulation start date plus alarelin (0.15 mg/d) to intramuscular injection of human chorionic gonadotropin (HCG) day.Thirty-five patients received ultra-long-term down-regulation protocol (group B).Triptorelin was injected intramuscularly in mid-luteal phase twice followed by triptorelin at a dose of 1.2-1.3 mg after 28 days of long-acting triptorehn treatment (1.5 mg).Gonadotropin was started 16 days after the second GnRHa injection.The dose of Gn,number of oocytes retrieved,number of embryos available,implantation rate,pregnancy rate,and miscarriage rate were recorded and compared between the two groups.Results There was no significant difference between the two groups in the mean age of participants,basal follicular number,FSH,the dose of Gn used,number of oocytes retrieved,number of embryos available,number of implanted embryos,Pregnancy rate(32.56％ vs.34.29％),implantation rate(18.75％ vs.20.97％) and miscarriage rate (0 vs.8.33％)(P ＞ 0.05).Conclusion No significant difference was found between the two groups in clinical pregnancy rate and abortion rate.But modified long-term protocol needs a shorter treatment period than the ultra-long-term protocol.Moreover,it reduces the risk of excessive suppression of pituitary function.Therefore,it takes advantages over the other in the clinical application.