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OBSTETRICS AND GYNAECOLOGY / CLINICAL RESEARCH
GnRH antagonist versus depot GnRH agonist protocol in polycystic ovary syndrome (PCOS): analysis using propensity score matching
1
Jiangxi Maternal and Child Health Hospital Affiliated to Nanchang University,
Nanchang, China
2
Columbia College of Art and Science, the George Washington University,
Washington, USA
Submission date: 2020-12-10
Final revision date: 2021-02-07
Acceptance date: 2021-02-21
Online publication date: 2021-03-20
Corresponding author
Qiongfang Wu
Jiangxi Maternal and Child Health Hospital Affiliated to Nanchang University Nanchang, China
Jiangxi Maternal and Child Health Hospital Affiliated to Nanchang University Nanchang, China
KEYWORDS
polycystic ovary syndromein vitro fertilizationGnRH antagonist protocoldepot GnRH agonist protocolpropensity score matching
TOPICS
ABSTRACT
Introduction:
Women with polycystic ovary syndrome (PCOS) have been reported to have a low pregnancy rate and high ovarian hyperstimulation syndrome (OHSS) risk in in vitro fertilization (IVF) programs due to the decreased endometrial receptivity and high ovarian reserve. The GnRH antagonist (GnRH-ant) protocol has been widely accepted as a prominent intervention to reduce the risk of OHSS, and been recommended as the preferred protocol. The depot GnRH agonist (dGnRH-a) protocol is believed to improve endometrial receptivity and increase the pregnancy rate of fresh embryo transfer. There have been no previous studies comparing the two protocols.
Material and methods:
This was a retrospective cohort study that included 2164 women with PCOS undergoing assisted reproductive technology (ART) treatment between January 2014 and April 2019. Among them, 2018 women received dGnRH-a protocol treatment and 146 women received GnRH-ant protocol treatment. The two groups were matched by propensity scores with a ratio of 4 : 1 to account for potential confounding factors. The primary outcomes were the live birth rate (LBR), incidence of moderate-to-severe OHSS and the cost of controlled ovarian hyperstimulation (COH). Live birth rate was defined as live births per treatment cycle after the first fresh or frozen embryo transfer.
Results:
The live birth rate per treatment cycle was higher in the dGnRH-a group than in the GnRH-ant group (58.22% vs. 41.78%, p = 0.0004), as was the live birth rate per fresh transfer (64.42% vs. 44.64%, p = 0.0045). However, the live birth rate per frozen transfer was similar in the two groups. There were no significant differences in the incidence of moderate-to-severe OHSS (4.28% vs. 2.05%, p = 0.333), the incidence of severe OHSS (0.17% vs. 0%, p = 1) and the cost of COH (RMB: 7736.9 vs. 8046.54, p = 0.113) between the two groups.
Conclusions:
Our results indicated that the dGnRH-a protocol had a higher live birth rate than the GnRH-ant protocol, and the difference was mainly due to fresh embryo transfer. Regarding safety and economic cost, the incidence of moderate-to-severe OHSS and cost of COH were similar in the two groups. The incidence of moderate-to-severe OHSS in the dGnRH-a group was higher than in the GnRH-ant group, but without statistical difference. A subsequent prospective randomized controlled study is needed to confirm these results.
Women with polycystic ovary syndrome (PCOS) have been reported to have a low pregnancy rate and high ovarian hyperstimulation syndrome (OHSS) risk in in vitro fertilization (IVF) programs due to the decreased endometrial receptivity and high ovarian reserve. The GnRH antagonist (GnRH-ant) protocol has been widely accepted as a prominent intervention to reduce the risk of OHSS, and been recommended as the preferred protocol. The depot GnRH agonist (dGnRH-a) protocol is believed to improve endometrial receptivity and increase the pregnancy rate of fresh embryo transfer. There have been no previous studies comparing the two protocols.
Material and methods:
This was a retrospective cohort study that included 2164 women with PCOS undergoing assisted reproductive technology (ART) treatment between January 2014 and April 2019. Among them, 2018 women received dGnRH-a protocol treatment and 146 women received GnRH-ant protocol treatment. The two groups were matched by propensity scores with a ratio of 4 : 1 to account for potential confounding factors. The primary outcomes were the live birth rate (LBR), incidence of moderate-to-severe OHSS and the cost of controlled ovarian hyperstimulation (COH). Live birth rate was defined as live births per treatment cycle after the first fresh or frozen embryo transfer.
Results:
The live birth rate per treatment cycle was higher in the dGnRH-a group than in the GnRH-ant group (58.22% vs. 41.78%, p = 0.0004), as was the live birth rate per fresh transfer (64.42% vs. 44.64%, p = 0.0045). However, the live birth rate per frozen transfer was similar in the two groups. There were no significant differences in the incidence of moderate-to-severe OHSS (4.28% vs. 2.05%, p = 0.333), the incidence of severe OHSS (0.17% vs. 0%, p = 1) and the cost of COH (RMB: 7736.9 vs. 8046.54, p = 0.113) between the two groups.
Conclusions:
Our results indicated that the dGnRH-a protocol had a higher live birth rate than the GnRH-ant protocol, and the difference was mainly due to fresh embryo transfer. Regarding safety and economic cost, the incidence of moderate-to-severe OHSS and cost of COH were similar in the two groups. The incidence of moderate-to-severe OHSS in the dGnRH-a group was higher than in the GnRH-ant group, but without statistical difference. A subsequent prospective randomized controlled study is needed to confirm these results.
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