The Efficiency Of GnRH Antagonist Compare To Long GnRH Agonist Protocol In Poor Ovarian Responders

Objective:To evaluate the efficiency of the GnRH antagonist and the long GnRH agonist protocol in poor ovarian responders and provide optimal evidence for treatment.Study design:This was a prospective randomized controlled trial performed in the Center of Guangxi Reproductive Medicine,The First Affiliated Hospital of Guangxi Medical University, from June to December 2015.There were 64 women characterised as poor ovarian responders included in this trial。Using random number table, they were assigned into two group according their arrival, odd number as long GnRH agonist protocol (n=31) and even number as GnRH antagonist protocol (n=33). Laboratory and clinical outcomes between the two COH protocols were measure.Results:NO significantly difference was observed in the character of age,male age,infertility history, previous IVF cycles, baseline FSH, baseline LH and AFC between the two groups. Patients in the antagonist group, however, had significantly higher base estradiol levels before starting stimulation (P=0.018). Laboratory outcomes such as constituent ratio of insemination method, rate of nomal fertilized eggs and morphologically good embryos,, LH level on HCG day and the endometrial thickness on transfer day were comparable in the fixed GnRH antagonist group to the standard long GnRH agonist group, while the latter had a significantly higher numbers of oocytes retrieved and embryos fortransferred (P<0.05). The level of E2 was higher in agonist group, difference was significantly (1672.89±937.91pg/ml vs 1398.60±653.69pg/ml P=0.023). HCG day Prog level was higher in antagonist group, difference was significantly (1.56±1.32ng/ml vs 0.87±0.57ng/ml, P=0.029).The implantation rates was significantly higher in agonist group(21.9% vs 7.4%, P=0.029). The mean time of gonadotropin stimulation and total dose of gonadotropin were significantly decreases in antagonist group (P<0.001).The clinical pregnancy rate was significantly lower in the antagonist compared to the agonist group (12.9%vs 35.5%, P=0.038). The morphologically good embryos、 implantation rate and clinical pregnancy rate were comparable with patients whose age on 35-40years old between the two protocols. Patients whose age older than 40 in the agonist group had a significantly higher morphologically good embryos rate than the antagonist group,while the implantation rate, and clinical pregnancy rate were comparable. The implantation rate, morphologically good embryos rate and clinical pregnancy rate were comparable between the two protocol with patients whose AFC less than 5. The implantation rate and clinical pregnancy rate in the antagonist group were significantly lower compared to the agonist with patients whose AFC equal or more than 5, but not the morphologically good embryos rate.Conclusions:1. The long GnRH agonist protocol appears to be more effective in poor responder women undergoing IVF treatment than the antagonist protocol as to numbers of oocytes retrieved, implantation rate and clinical pregnancy rates, especially those with AFC equal or more than 5 could benefit more by using the long GnRH agonist protocol.2. GnRH antagonist protocol is considerable in patients with AFC less than 5, since it showed a significantly reduction in the mean time of gonadotropin stimulation and total dose of FSH, relieving patients economical burden.3. Much effort should be done and more trials be modified when using GnRH antagonist protocol to provide alternative choice for patients diagnosed poor ovarian responders.