Comparison Of In-vitro Fertilization Outcomes Between Luteal Phase Stimulation And Mild Stimulation Protocol In Women With A Prior Poor Ovarian Response

?Objective?Poor ovarian response?POR?is one of the most intractable challenges in the field of reproductive medicine,defined as the pathological state of a low response to to ovulation drugs,resulted in a reduced number of follicles,oocytes retrieved and viable embryos for transfer,which leads to lower pregnancy rates and higher cancellation rates.The cancellation of the cycle caused by the low ovarian response not only leads to economic loss,but also brings great pressure to the family.With the full opening of China's second-born child policy and the delay of childbearing,the increasing number of elderly women with POR has become the most challenging clinical problem in assisted reproductive technology.In recent years,some scholars have proposed a new treatment strategy for patients with previous unsatisfied outcomes under the conventional regimens in ART treatment,which was promising.The purpose of this study was to compare the clinical outcome between and luteal phase stimulation protocol and mild stimulation protocol in patients with POR undergoing IVF treatment.?Methods?A total of 622 POR patients underwent IVF/ICSI treatment from the Department of Reproductive Center of the Third Affiliated Hospital of Guangzhou Medical University from December 2013 to December 2017 were selected.Among these,506patients received micro-stimulation protocol treatment and 116 patients received LPS protocol treatment.Inclusion criteria:meet the IVF/ICSI indications;AMH<1.1ng/ml;?3 oocytes retrieved with a conventional stimulation protocol in the first started cycle;second started cycle using micro-stimulation protocol or luteal phase stimulation protocol.Grouping:According to different protocols applied,patients were divided into two groups:mild stimulation group?group MS?and luteal phase stimulation group?group LPS?.According to serum AMH levels,patients were divided into two group,:AMH<0.5 ng/ml group and 0.5 ng/ml?AMH<1.1 ng/ml group,stratified comparisons were performed.?Results?1.There was no significant difference in patients general information,such as age,infertility period,infertility type,body mass index,serum AMH levels and the ratio of FSH to LH between group LPS and group MS?P>0.05?.The average age of group LPS was 38.27±4.03 years old,higher than that of group MS?37.51±4.93 years old?,but the difference was not statistically significant?P>0.05?.2.The mean gonadotrophin dose and numbers of days in utilization of gonadotrophin in group LPS were higher than those in group MS,but the difference was not statistically significant?P>0.05?.The E₂ level on HCG administration day in group LPS was lower than that in group MS,and LH level on HCG administration day in group LPS was higher than that in group MS,but the difference was not statistically significant?P>0.05?.The serum progesterone level on HCG administration day was significantly higher in group LPS than in group MS?P<0.01?.In group LPS,no-oocyte-retrieved cycle rate was 16.5%,significantly higher than that of group MS,which was 7.4%?P<0.05?.No statistically significant differences in the oocyte retrieval cancellation rate and the no-viable-embryo cycle rate between two groups.?P>0.05?.No statistically significant differences in the mean number of oocytes retrieved,fertilization rate,oocyte utilization rate,the mean number of viable embryos,and the mean number of good embryos between two groups?P>0.05?.3.In group LPS,with 59 cycles for embryo transfer,the clinical pregnancy rate was 23.7%,the early pregnancy loss rate was 8.7%,and the ongoing pregnancy rate was 15.3%;while group MS,299 cycles for embryo transfer,the clinical pregnancy rate was 35.5%,the rate of early pregnancy loss was 35.5%and the ongoing pregnancy rate was 25.4%.There was no statistical difference?P>0.05?.4.The cumulative clinical pregnancy rate per started cycle was 13.0%and cumulative pregnancy rate per oocytes retrieval was 13.9%in group LPS,which was significantly lower than those in group MS,in which the cumulative clinical pregnancy rate per started cycle was 22.2%,and the cumulative ongoing pregnancy rate per oocytes retrieval cycle was 23.3%?P<0.05?.No statistically significant differences in the cumulative ongoing pregnancy rate per started cycle and the cumulative ongoing pregnancy rate per oocytes retrieval cycle between two groups?P<0.05?.5.In patients with AMH<0.5ng/ml,the mean number of oocytes retrieved,the mean number of viable embryos,and the mean number of good embryos in group LPS were higher than group MS,the difference was statistically significant?P<0.05?.The clinical pregnancy rate per transfer cycle in group LPS was 8.7%and the clinical pregnancy rate per oocytes retrieval cycle was 4.3%,the clinical pregnancy rate per started cycle was 4.0%,which were lower than in group MS?32.6%,27.9%,27.9%??P<0.05?.In group LPS,the ongoing pregnancy rate per started cycle was2.2%,the ongoing pregnancy rate per started cycle was 2.0%,both were lower than that in group MS?16.3%,16.3%??P<0.05?.No statistically significant differences in the early pregnancy loss rate and the sustained pregnancy rate per transfer cycle between two groups?P>0.05?.6.In patients with AMH?0.5ng/ml and<1.1 ng/ml,he mean number of oocytes retrieved,the mean number of viable embryos,and the mean number of good embryos in group LPS were higher than group MS,the difference was statistically significant?P<0.05?.No statistically significant differences in pregnancy rates?P>0.05?.?Conclusion?1.For patients with POR,the LPS protocol is similar to the mild stimulation protocol in the ovulation induction and clinical outcomes.2.POR patients with diminished ovarian reserve near terminal levels?AMH<0.5ng/ml?may prefer mild stimulation protocol.3.The LPS protocol is a viable treatment for POR patients with diminished ovarian reserve but still at a certain level?0.5ng/ml?AMH<1.1ng/ml?.