Live Birth Outcomes for PCOS Patients Under the Follicular-Phase Long-Acting GnRH Agonist Protocol or Antagonist Protocol - A Retrospective Chinese Cohort

Overview

Journal J Multidiscip Healthc

Publisher Dove Medical Press

Specialty Health Services

Date 2023 Sep 27

PMID 37753342

Authors

Jiajia Zhai

Junyan Zhang

Jingfang He

Minzhi Lv

Bozheng Zhang

Guanqun Li

Yuanjie Du

Guimin Hao

Affiliations

Soon will be listed here.

Abstract

Objective: For patients with polycystic ovary syndrome (PCOS) to undergo in vitro fertilization (IVF) and embryo transfer (ET), there has been no consensus regarding which protocol is the most optimal for live birth rate in fresh cycles. We sought to evaluate depot gonadotropin-releasing hormone (GnRH) agonist protocol versus GnRH antagonist protocol in IVF outcomes for PCOS patients in a single fertility center.

Methods: In this retrospective cohort, PCOS patients who visited the Second Hospital of Hebei Medical University reproductive center between February 2012 and December 2019 were screened, and 533 PCOS infertility patients were included undergoing their first IVF cycle, with 470 in the depot GnRH agonist group and 63 in the GnRH antagonist group. The primary of this study outcome was the fresh live birth rate (LBR).

Results: PCOS women in the depot GnRH agonist group had a higher LBR (49.79%) than those in the GnRH antagonist group (34.92%, p = 0.027). The multivariable logistic regression also confirmed that women in the depot GnRH agonist group had a higher LBR than those in the GnRH antagonist group (OR = 1.83, 95% CI 1.05~3.18, p = 0.032). After propensity score matching (PSM), the LBR in the depot GnRH agonist group was higher (50.32%) than that of the GnRH antagonist group (35.48%), p = 0.033. The ovarian hyperstimulation syndrome (OHSS) rates were similar between the two groups, with 35 in the depot GnRH group and 6 in the GnRH antagonist group (p = 0.561).

Conclusions: For PCOS patients in fresh embryo transfer cycles, the depot GnRH agonist protocol may lead to a higher LBR than the antagonist protocol with satisfied lower OHSS rates.

References

Shi Y, Sun Y, Hao C, Zhang H, Wei D, Zhang Y . Transfer of Fresh versus Frozen Embryos in Ovulatory Women. N Engl J Med. 2018; 378(2):126-136. DOI: 10.1056/NEJMoa1705334. View

Drakopoulos P, Racca A, Errazuriz J, De Vos M, Tournaye H, Blockeel C . The role of progesterone elevation in IVF. Reprod Biol. 2019; 19(1):1-5. DOI: 10.1016/j.repbio.2019.02.003. View

Duffy J, Bhattacharya S, Bofill M, Collura B, Curtis C, Evers J . Standardizing definitions and reporting guidelines for the infertility core outcome set: an international consensus development study. Fertil Steril. 2020; 115(1):201-212. DOI: 10.1016/j.fertnstert.2020.11.013. View

Li L, Liu L, Kou Z, Huo M, An J, Zhang X . GnRH agonist treatment regulates IL-6 and IL-11 expression in endometrial stromal cells for patients with HRT regiment in frozen embryo transfer cycles. Reprod Biol. 2022; 22(2):100608. DOI: 10.1016/j.repbio.2022.100608. View

Wang B, Wang J, Liu Y, Wang L, Du M, Zhang Z . sRAGE downregulates the VEGF expression in OHSS ovarian granulosa cells. Gynecol Endocrinol. 2021; 37(9):836-840. DOI: 10.1080/09513590.2021.1942453. View

Hortu I, Karadadas E, Ozceltik G, Tavmergen E, Goker E, Yigitturk G . Oxytocin and cabergoline alleviate ovarian hyperstimulation syndrome (OHSS) by suppressing vascular endothelial growth factor (VEGF) in an experimental model. Arch Gynecol Obstet. 2020; 303(4):1099-1108. DOI: 10.1007/s00404-020-05855-1. View

Tandulwadkar S, Gupta S, Singh A, Mishra S, Singhania S . Medroxyprogesterone Acetate versus Gonadotropin-Releasing Hormone Antagonist for the Prevention of Premature Luteinizing Hormone Surge in hyper-responder women undergoing controlled ovarian stimulation for IVF/ICSI Cycles. JBRA Assist Reprod. 2022; 27(1):15-19. PMC: 10065783. DOI: 10.5935/1518-0557.20220006. View

Lizneva D, Suturina L, Walker W, Brakta S, Gavrilova-Jordan L, Azziz R . Criteria, prevalence, and phenotypes of polycystic ovary syndrome. Fertil Steril. 2016; 106(1):6-15. DOI: 10.1016/j.fertnstert.2016.05.003. View

Zhang D, Zhang D, Sun Z, Deng C, Yu Q, Zhen J . The effect of a transient premature luteinizing hormone surge without elevated serum progesterone on in vitro fertilization outcomes in a gonadotropin-releasing hormone antagonist flexible protocol. Gynecol Endocrinol. 2019; 36(6):550-553. DOI: 10.1080/09513590.2019.1683730. View

10.

Joham A, Norman R, Stener-Victorin E, Legro R, Franks S, Moran L . Polycystic ovary syndrome. Lancet Diabetes Endocrinol. 2022; 10(9):668-680. DOI: 10.1016/S2213-8587(22)00163-2. View

11.

Zehravi M, Maqbool M, Ara I . Polycystic ovary syndrome and infertility: an update. Int J Adolesc Med Health. 2021; 34(2):1-9. DOI: 10.1515/ijamh-2021-0073. View

12.

Song J, Wu W, Jiang L, Duan C, Xu J . Effects of Different Exposure Days to Gonadotropin-Releasing Hormone Agonist (GnRH-a) on Live Birth Rates in the Depot GnRH-a Protocol: A Retrospective Analysis of 7007 Cycles. Med Sci Monit. 2021; 27:e929854. PMC: 8034236. DOI: 10.12659/MSM.929854. View

13.

Costello M, Garad R, Hart R, Homer H, Johnson L, Jordan C . A Review of Second- and Third-line Infertility Treatments and Supporting Evidence in Women with Polycystic Ovary Syndrome. Med Sci (Basel). 2019; 7(7). PMC: 6681353. DOI: 10.3390/medsci7070075. View

14.

Zegers-Hochschild F, Adamson G, Dyer S, Racowsky C, de Mouzon J, Sokol R . The International Glossary on Infertility and Fertility Care, 2017. Fertil Steril. 2017; 108(3):393-406. DOI: 10.1016/j.fertnstert.2017.06.005. View

15.

Wang N, Zhu Q, Ma M, Liang Z, Tao Y, Wang Y . Comparison of a progestin-primed ovarian stimulation protocol with a flexible GnRH antagonist protocol in patients with polycystic ovary syndrome who are participating in an IVF programme: study protocol for a randomised controlled trial. BMJ Open. 2020; 10(12):e038153. PMC: 7713223. DOI: 10.1136/bmjopen-2020-038153. View

16.

Xu B, Geerts D, Hu S, Yue J, Li Z, Zhu G . The depot GnRH agonist protocol improves the live birth rate per fresh embryo transfer cycle, but not the cumulative live birth rate in normal responders: a randomized controlled trial and molecular mechanism study. Hum Reprod. 2020; 35(6):1306-1318. DOI: 10.1093/humrep/deaa086. View

17.

Li G, Wu Y, Niu W, Xu J, Hu L, Shi H . Analysis of the Number of Euploid Embryos in Preimplantation Genetic Testing Cycles With Early-Follicular Phase Long-Acting Gonadotropin-Releasing Hormone Agonist Long Protocol. Front Endocrinol (Lausanne). 2020; 11:424. PMC: 7386196. DOI: 10.3389/fendo.2020.00424. View

18.

Kadoura S, Alhalabi M, Nattouf A . Conventional GnRH antagonist protocols versus long GnRH agonist protocol in IVF/ICSI cycles of polycystic ovary syndrome women: a systematic review and meta-analysis. Sci Rep. 2022; 12(1):4456. PMC: 8924277. DOI: 10.1038/s41598-022-08400-z. View

19.

Yang R, Guan Y, Perrot V, Ma J, Li R . Comparison of the Long-Acting GnRH Agonist Follicular Protocol with the GnRH Antagonist Protocol in Women Undergoing In Vitro Fertilization: A Systematic Review and Meta-analysis. Adv Ther. 2021; 38(5):2027-2037. PMC: 8107074. DOI: 10.1007/s12325-020-01612-7. View

20.

Al-Inany H, Youssef M, Ayeleke R, Brown J, Lam W, Broekmans F . Gonadotrophin-releasing hormone antagonists for assisted reproductive technology. Cochrane Database Syst Rev. 2016; 4:CD001750. PMC: 8626739. DOI: 10.1002/14651858.CD001750.pub4. View