Comparative Study Of Clinical Outcomes And Health Economics Between Luteal Phase Long-acting Protocol And GnRH-antagonist Protocol In IVF-ET In Patients With Normal Ovarian Response

Objective(s):To study the effect of the Luteal phase long-acting protocol and the GnRH-antagonist protocol in the process of in vitro fertilization-embryo transfer(IVF-ET)in patients with normal ovarian response,and conduct a cost-effectiveness analysis of the two COH regimens from an economic perspective,to provide reference for clinicians to choose safe,effective and reasonable IVE-ET assisted reproduction schemes for patients with normal ovarian response.Methods:Retrospectively analyzed 280 patients who received IVF-ET assisted fertility treatment with Luteal phase long-acting protocol or GnRH-antagonist protocol in the Department of Reproductive Genetics of the First Affiliated Hospital of Kunming Medical University and expected normal ovarian response from January 2018 to December 2019.Divided into two groups according to the COH regimen.Among them,there were 141 patients with Luteal phase long-acting protocol(group A)and 139 patients with GnRH-antagonist protocol(group B).The clinical outcomes and the time to live birth were compared between the two groups,and the cost-effectiveness analysis was conducted for the two groups.Results:1.General information:There were no statistical differences in age,anti-Mullerian hormone(AMH),basal antral follicle count(AFC),body mass index(BMI),basal follicle stimulating hormone(FSH),basal luteinizing hormone(LH)and other general conditions between the two groups(P>0.05).In terms of infertility types,the proportion of primary infertility in group A was significantly lower than that in group B,while the proportion of secondary infertility was significantly higher than that in group B,in which the proportion of primary infertility was 35.5%and 48.9%,and the proportion of secondary infertility was 64.5%and 51.1%,respectively(P<0.05).2.COH:E2 on day of hCG(3864.39±1829.44 VS 3113.58±1761.89),P(1.10±0.66 VS 0.93±0.62),endometrial thickness on day of hCG(11.10±2.62 VS10.12±2.36),total Gn(3453.19±1176.93 VS 2705.04±790.67)and Gn days(12.20±1.42 VS 9.82±1.61)were higher than those in group B,and the difference was statistically significant(P<0.05).The LH levels of group B on day of hCG was higher than that of group A(3.08±2.73 VS 1.40±0.72),and the difference was statistically significant(P<0.001).There was no significant difference in the FSH levels on day of hCG and the incidence of moderate and severe OHSS between the two regimens(P>0.05).3.Outcome of Egg retrieval,Fresh Embryo Transfer(ET),Freeze Embryo Transfer(FET):In group A,the number of eggs obtained(12.61±5.37 VS 10.18±4.70,P<0.001),the number of mature eggs(11.30±4.81 VS 9.34±4.53,P=0.001),the number of blastocyst formation(3.18±3.40 VS 2.17±3.18,P=0.01)were significantly higher than those in group B.There was no significant difference between the two groups in terms of the number of embryos,the rate of excellent embryo,the positive rate of β-HCG,the rate of live birth,the rate of clinical pregnancy and the rate of abortion(P>0.05).FET outcome:There were no significant differences in the clinical outcome indexes such as pregnancy rate and live birth rate between the two regimens(P>0.05).4.Comparison after combining ET and FET:The cumulative clinical pregnancy rate of group A was significantly higher than that of group B(68.8%VS 56.8%,P<0.05).Although the cumulative live birth rate was also better than the latter,the difference was not statistically significant(P>0.05).The time to live birth in group B was significantly lower than that in group A(10.35±2.14 VS 12.29±4.08,P<0.001).5.Cost-effectiveness analysis:In the ET cycle,the cost of COH drugs in group A(8528.96±1786.47 VS 7062.95±1739.37),auxiliary examination cost(5034.07±161.15 VS 4880.01±182.58),and total cost(21875.00±2238.18 VS 20083.13±2230.08)were significantly higher than group B.the difference was statistically significant(P<0.001).The cost per mature egg obtained in group A(1936.21 VS 2150.66)and the cost per high-quality embryo obtained(5157.82 VS 5368.37)are lower than those in group B,but the cost per live birth obtained in group B is lower than that in group A(44928.70 VS 54687.50);After merging the ET and FET cycles,the average cost of each live birth in group A is lower than that in group B,group A is ￥ 40318.13,group B is ￥ 42,126.52,and the incremental cost-effectiveness ratio is ￥ 27,307.08.Conclusion(s):1.For patients with normal ovarian response,the clinical outcomes of the GnRH-antagonist protocol and the Luteal phase long-acting protocol are similar,but the incidence of OHSS is lower in the GnRH-antagonist protocol.In addition,the GnRH-antagonist protocol has a shorter time to live birth,and the treatment cost of the fresh embryo transfer cycle is lower,which deserves more attention.2.After the combined analysis of the fresh embryo transfer and frozen embryo transfer cycles,the Luteal phase long-acting protocol has more economic advantages.3.It is recommended that clinicians and patients choose different treatment regimens according to the patient’s needs for treatment time and economic costs.For patients with higher treatment time requirements,the GnRH-antagonist protocol is preferred;for patients with higher economic cost requirements,the Luteal phase long-acting protocol may be preferred.