Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University, Chongqing, China.
Joint International Research Laboratory of Reproduction and Development of the Ministry of Education of China, School of Public Health, Chongqing, China.
Front Endocrinol (Lausanne). 2022 Jul 22;13:899000. doi: 10.3389/fendo.2022.899000. eCollection 2022.
The GnRH agonist long-acting protocol and GnRH antagonist protocol are widely used in ovarian stimulation. Which protocol eliciting higher live birth rate for IVF/ICSI patients with different ages, different ovarian reserves and different body mass index (BMI) has not been studied. However, among these protocols, the one that elicits higher live birth in IVF/ICSI patients with different ages, ovarian reserves and body mass indexes (BMI) has not been identified.
This was a retrospective cohort study about 8579 women who underwent the first IVF-ET from January, 2018 to August, 2021. Propensity Score Matching (PSM) was used to improve the comparability between two protocols.
After PSM, significant higher live birth rates were found in the GnRH agonist long-acting protocol compared to GnRH antagonist protocol (44.04% vs. 38.32%) (p<0.001). Stratified analysis showed that for those with AMH levels between 3 ng/ml and 6 ng/ml, with BMI ≥ 24 kg/m and were aged ≥ 30 years old, and for those women with BMI < 24kg/m and were aged ≥30 years whose AMH levels were ≤ 3ng/ml, the GnRH agonist long-acting protocol was more likely to elicit live births [OR (95%CI), 2.13(1.19,3.80)], [OR (95%CI), 1.41(1.05,1.91)]. However, among women with BMI ≥ 24kg/m and were aged ≥30 years whose AMH levels were ≤ 3ng/ml, the GnRH agonist long-acting protocol had a lower possibility of eliciting live births [OR (95%CI), 0.54(0.32,0.90)]. Also, among women with AMH levels between 3 ng/ml and 6 ng/ml, with BMI ≥ 24 kg/m and with age < 30 years and for those with AMH levels between 3 ng/ml and 6 ng/ml, regardless of age, and with BMI<24kg/m2,, the possibility of live births was similar between the two protocols [OR (95%CI), 1.06(0.60,1.89)], [OR (95%CI), 1.38(0.97,1.97)], [OR (95%CI), 0.99(0.72,1.37)]. Among the women with AMH levels ≤ 3 ng/ml and with were aged < 30years, regardless of BMI, the possibility of live birth was similar between the two protocols [OR (95%CI), 1.02(0.68,1.54)], [OR (95%CI), 1.43(0.68,2.98)]. Moreover, among women with AMH levels ≥ 6ng/ml, the possibility of live birth was similar between the two protocols [OR (95%CI),1.42(0.75,2.69)], [OR (95%CI),1.02(0.19,5.35)], [OR (95%CI), 1.68(0.81,3.51)], [OR (95%CI), 0.51(0.10,2.55)].
The suitability of the GnRH agonist long-acting protocol or GnRH antagonist protocol to infertility patients is dependent on specific biological characteristics of the patients.
促性腺激素释放激素激动剂长效方案和促性腺激素释放激素拮抗剂方案广泛应用于卵巢刺激。对于不同年龄、不同卵巢储备和不同体重指数（BMI）的 IVF/ICSI 患者，哪种方案能产生更高的活产率，目前尚未研究。然而，在这些方案中，哪一种方案能在不同年龄、卵巢储备和体重指数（BMI）的 IVF/ICSI 患者中产生更高的活产率尚未确定。
这是一项回顾性队列研究，共纳入了 8579 名于 2018 年 1 月至 2021 年 8 月期间首次接受 IVF-ET 的女性。采用倾向性评分匹配（PSM）来提高两种方案的可比性。
PSM 后，促性腺激素释放激素激动剂长效方案的活产率显著高于促性腺激素释放激素拮抗剂方案（44.04% vs. 38.32%）（p<0.001）。分层分析显示，对于 AMH 水平在 3ng/ml 至 6ng/ml 之间、BMI≥24kg/m2 且年龄≥30 岁的患者，以及 BMI<24kg/m2 且年龄≥30 岁且 AMH 水平≤3ng/ml 的患者，促性腺激素释放激素激动剂长效方案更有可能引发活产[OR（95%CI），2.13（1.19，3.80）]；[OR（95%CI），1.41（1.05，1.91）]。然而，对于 BMI≥24kg/m2 且年龄≥30 岁且 AMH 水平≤3ng/ml 的患者，促性腺激素释放激素激动剂长效方案引发活产的可能性较低[OR（95%CI），0.54（0.32，0.90）]。此外，对于 AMH 水平在 3ng/ml 至 6ng/ml 之间、BMI≥24kg/m2 且年龄<30 岁的患者，以及 AMH 水平在 3ng/ml 至 6ng/ml 之间、无论年龄和 BMI<24kg/m2 的患者，两种方案引发活产的可能性相似[OR（95%CI），1.06（0.60，1.89）]；[OR（95%CI），1.38（0.97，1.97）]；[OR（95%CI），0.99（0.72，1.37）]。对于 AMH 水平≤3ng/ml 且年龄<30 岁的患者，无论 BMI 如何，两种方案引发活产的可能性相似[OR（95%CI），1.02（0.68，1.54）]；[OR（95%CI），1.43（0.68，2.98）]。此外，对于 AMH 水平≥6ng/ml 的患者，两种方案引发活产的可能性相似[OR（95%CI），1.42（0.75，2.69）]；[OR（95%CI），1.02（0.19，5.35）]；[OR（95%CI），1.68（0.81，3.51）]；[OR（95%CI），0.51（0.10，2.55）]。
促性腺激素释放激素激动剂长效方案或促性腺激素释放激素拮抗剂方案对不孕患者的适用性取决于患者的特定生物学特征。
