Comparison Of Different Controlled Ovarian Stimulation Protocols Efficacy In Women With Diminished Ovarian Reserve

Chapter?Effects of short and long protocols on controlled ovarian stimulation in patients with diminished ovarian reserveBackground:Diminished ovarian reserve(DOR)is encountered frequently in infertility treatment and describes the reduced response of women of childbearing age to ovarian stimulation or fertility.In recent years,its incidence has been increasing year by year and getting younger.How to accurately evaluate the diminished ovarian reserve and select the appropriate ovulation induction program to improve the outcome of assisted reproduction and assisted pregnancy in DOR patients is the focus and difficulty of reproductive clinicians.The objective of this study was to compare the efficiency of short and long protocols on patients with DOR undergoing IVF/ICSI.Methods:A total of 4311 infertile patients with DOR(antral follicle count<7 or anti-Mullerian hormone<1.1 ng/mL)who underwent IVF/CSI between November 2013 and February 2017 were included in this retrospective cohort study.3188 were treated with a short protocol(Group S),and 1123 patients were treated with a long protocol(Group L).In each group,the patients were further divided into five age groups:?30,31-34,35-37,38-40 and>40 years.Results:1.In age groups of ?30,31-34 and 35-37,patients treated with a long protocol showed a significantly higher live birth rate and biochemical pregnancy rate compared with the short protocol patients even after adjustment of age,basal FSH levels,basal serum AMH,basal antral follicle counts and treatment groups.2.In 38-40 and>40 age groups the live birth rate and biochemical pregnancy rate did not show any statistically significant differences between long or short protocols.3.For laboratory indexes of the number of oocytes retrieved,Day-3(D3)high-quality embryos and 2 pronuclei(2PN),long protocol was better than short protocol in all age groups.4.There were no significant differences in early miscarriage rate and cycle cancellation rate between the two protocols.Conclusion:In patients of age<38 years,the long protocol performed better than the short protocol for patients with DOR.However,for groups over 38 years old,there was no significant difference in pregnancy outcomes between different protocols.Chapter? Comparison of different controlled ovarian stimulation protocols efficacy in women with diminished ovarian reserveBackground:In recent years,gonadotropin-releasing hormone antagonists(GnRH-A)have been widely used in various women assisted by in vitro fertilization due to their advantages of short treatment cycle,flexible use and low incidence of ovarian hyper-stimulation.Gonadotropin-releasing hormone antagonist protocol is still a second-line treatment for controlled ovarian stimulation in patients with diminished ovarian reserve(DOR),and literatures reporting on its clinical application effect is not consistent.This study evaluated whether the GnRH-A protocol was superior to the long and short protocol by comparing the efficiency of short,long and gonadotropin-releasing hormone antagonist protocol on patients with DOR.Methods:A total of 5213 infertile patients with DOR(antral follicle count<7 or anti-Mullerian hormone<1.1 ng/mL)who underwent their first IVF/ICSI cycle between January 2015 and September 2018 were included in this study.787 were treated with long protocol(Group L),3671 patients were treated with short protocol(Group S)and 755 were treated with GnRH antagonist protocol(Group A).In each group,the patients were further divided into two age groups:<38 and?38 years.Results:1.The live birth rate in women for the age of<38 with Group L,Group S and Group A were 37.4%,28.5%and 29.3%,respectively.Compared with Group S and Group A,women with Group L had a higher rate of live birth,a higher rate of clinical pregnancy and a lower rate of cancellation in<38 years even after adjustment of age,basal FSH levels,basal serum AMH,basal antral follicle counts and treatment groups.3.Pairwise comparisons showed that the live birth rate was significantly lower with Group A compared with the Group S(11.0%vs.6.4%,OR adj:0.55,95%CI:0.31-0.98,P adj=0.042)in?38 group even after adjustment.3.For the number of oocytes retrieved,2PN and Day-3 high-quality embryos,Group L was the highest among three protocols and had statistical differences in all age groups.4.Short protocols had the highest LH level on the day of HCG among three protocols in all age groups.Compared with Group L and Group S,patients with Group A had a lower rate of clinical pregnancy and a higher rate of cancellation in?38 years.Conclusion:1.In<38 years,long protocol was more advantageous for women with diminished ovarian reserve,then the GnRH antagonist protocol,and last the short protocol.2.In?38 years,long protocol and short protocol offer a suitable choice,whereas the GnRH antagonist protocol is less effective due to lower live birth rate and higher cancellation rate.