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Zhai J, Zhang J, He J, Lv M, Zhang B, Li G, Du Y, Hao G. Live Birth Outcomes for PCOS Patients Under the Follicular-Phase Long-Acting GnRH Agonist Protocol or Antagonist Protocol - A Retrospective Chinese Cohort. J Multidiscip Healthc 2023; 16:2781-2792. [PMID: 37753342 PMCID: PMC10518358 DOI: 10.2147/jmdh.s432936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 09/14/2023] [Indexed: 09/28/2023] Open
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.
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Affiliation(s)
- Jiajia Zhai
- Department of Reproductive Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, People’s Republic of China
| | - Junyan Zhang
- Shanxi Bethune Hospital, Shanxi Academy Of Medical Sciences, Department of Clinical Epidemiology and Evidence-Based Medicine, Taiyuan, People’s Republic of China
- Bothwin Clinical Study Consultant, Shanghai, People’s Republic of China
| | - Jingfang He
- Bothwin Clinical Study Consultant, Shanghai, People’s Republic of China
| | - Minzhi Lv
- Department of Biostatistics, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
- Center of Evidence-Based Medicine, Fudan University, Shanghai, People’s Republic of China
| | - Bozheng Zhang
- Department of Psychology, College of Arts and Sciences, University of Washington, Seattle, WA, 98053, USA
| | - Guanqun Li
- Technoderma Medicines Inc, Shanghai, People’s Republic of China
| | - Yuanjie Du
- Department of Reproductive Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, People’s Republic of China
| | - Guimin Hao
- Department of Reproductive Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, People’s Republic of China
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Tian Y, Zhang L, Qi D, Yan L, Song J, Du Y. Efficacy of long-term pituitary down-regulation pretreatment prior to in vitro fertilization in infertile patients with endometriosis: A meta-analysis. J Gynecol Obstet Hum Reprod 2023; 52:102541. [PMID: 36690299 DOI: 10.1016/j.jogoh.2023.102541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/12/2023] [Accepted: 01/18/2023] [Indexed: 01/22/2023]
Abstract
Controversial conclusions have been made in previous studies regarding the influence of ultra-long gonadotropin-releasing hormone agonist (GnRH-a) in the reproductive outcomes of women with endometriosis who are undergoing in vitro fertilization/ intracytoplasmic sperm injection embryo transfer (IVF/ICSI-ET). An electronic search was conducted through PubMed, Embase, Cochrane Library, Web of Science, Elsevier ScienceDirect and Medline from inception until 10 September 2022. Only randomized studies were included. After the selection process, seven articles were eventually included in the meta-analysis. The pooling of the results showed the adverse effect of ultra-long protocol in terms of live birth rate (risk ratio (RR) = 0.53, 95% confidence intervals (CI): 0.31-0.9, P=0.02) and fertilization rate (RR = 1.18, 95% CI: 1.02-1.36, P=0.02). There was no statistical significance between the ultra-long protocol and long protocol of the rest outcome Indicators. The findings of this meta-analysis suggest that ultra-long GnRH-a does not appear to improve the results of IVF/ICSI treatment outcomes in patients with endometriosis.
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Affiliation(s)
- Yizheng Tian
- Center for Reproductive Medicine, Shandong University, Jinan 250100, China; Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan 250100, China; Shandong Key Laboratory of Reproductive Medicine, Jinan 250012, China; Medical Integration and Practice Center, Shandong University, 44 Wenhuaxi Road, Jinan 250100, China; Gynecology Department, Reproductive Hospital Affiliated to Shandong University, Jinan 250001, China
| | - Lixia Zhang
- Maternal and Child Health and Family Planning Service Center of Yanggu County, Liaocheng 252300, China
| | - Dan Qi
- Center for Reproductive Medicine, Shandong University, Jinan 250100, China; Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan 250100, China; Shandong Key Laboratory of Reproductive Medicine, Jinan 250012, China; Medical Integration and Practice Center, Shandong University, 44 Wenhuaxi Road, Jinan 250100, China; Gynecology Department, Reproductive Hospital Affiliated to Shandong University, Jinan 250001, China
| | - Lei Yan
- Center for Reproductive Medicine, Shandong University, Jinan 250100, China; Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan 250100, China; Shandong Key Laboratory of Reproductive Medicine, Jinan 250012, China; Medical Integration and Practice Center, Shandong University, 44 Wenhuaxi Road, Jinan 250100, China; Gynecology Department, Reproductive Hospital Affiliated to Shandong University, Jinan 250001, China
| | - Jialun Song
- Center for Reproductive Medicine, Shandong University, Jinan 250100, China; Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan 250100, China; Shandong Key Laboratory of Reproductive Medicine, Jinan 250012, China; Medical Integration and Practice Center, Shandong University, 44 Wenhuaxi Road, Jinan 250100, China; Gynecology Department, Reproductive Hospital Affiliated to Shandong University, Jinan 250001, China.
| | - Yanbo Du
- Center for Reproductive Medicine, Shandong University, Jinan 250100, China; Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan 250100, China; Shandong Key Laboratory of Reproductive Medicine, Jinan 250012, China; Medical Integration and Practice Center, Shandong University, 44 Wenhuaxi Road, Jinan 250100, China; Gynecology Department, Reproductive Hospital Affiliated to Shandong University, Jinan 250001, China.
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Gui J, Ni Y, Liu Q, Wang X, Xie Q. Comparison of clinical effects between early follicular prolonged GnRH agonist protocol and GnRH antagonist protocol in 3310 cycles: a retrospective study. BMC Pregnancy Childbirth 2022; 22:942. [PMID: 36522703 PMCID: PMC9756476 DOI: 10.1186/s12884-022-05295-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND It is the duty of doctors to choose a safe, simple, economic and effective controlled ovulation stimulation (COS) protocol for the patients. This study aims to compare the clinical effects of the early follicular prolonged GnRH agonist (EFPL) and GnRH antagonist (GnRH-Ant) protocols, hoping to provide some reference for clinicians when choosing COS program. METHODS A retrospective study included 3310 ovum pick up cycles undergoing assisted reproductive technology during January 2019 to May 2022 in Renmin Hospital of Wuhan University. Propensity Score Matching (PSM) and multivariable logistic regression analysis were used to improve the comparability between the two protocols. Subgroups were divided according to age, body mass index (BMI) and anti-Mullerian hormone (AMH). The live birth rate (LBR) and clinical pregnancy rate (CPR) were the primary outcomes. RESULTS After PSM, the endometrial thickness, fresh embryo transplantation rate, chemical pregnancy rate, CPR were significantly higher in EFPL group than that in GnRH-Ant group (P < 0.001). The E2, LH, P values on trigger day were significantly lower in EFPL group (P < 0.001). The cycle cancellation rate was significantly reduced in EFPL group (P < 0.001). However, the total amount of Gn and duration of Gn were significantly increased in the EFPL group (P < 0.001). Multivariable logistic regression analysis showed that the LBR was significantly higher in EFPL group after matching [OR (95%CI), 1.86 (1.13, 3.05), P = 0.02], especially for those with age < 35 years [OR (95%CI), 1.95 (1.14, 3.34), P = 0.02], BMI < 24 kg/m2 [OR (95%CI), 2.08 (1.14, 3.80), P = 0.02], AMH levels ≥ 4.5 ng/ml [OR (95%CI), 4.19 (1.53, 11.43), P < 0.01]. CONCLUSION EFPL regimen is more suitable to elicit live birth for those young patients with BMI < 24 kg/m2 and AMH ≥ 4.5 ng/ml. However, for patients with decreased ovarian reserve or advanced age, EFPL regimen has no advantage over the GnRH-Ant regimen.
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Affiliation(s)
- Juan Gui
- grid.412632.00000 0004 1758 2270Dept. of Reproductive center, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuchang District, 430060 Wuhan, China ,Assisted Reproduction and Embryogenesis Clinical Research Center of Hubei Province, Wuhan, China
| | - Yuan Ni
- grid.412632.00000 0004 1758 2270Dept. of Reproductive center, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuchang District, 430060 Wuhan, China ,Assisted Reproduction and Embryogenesis Clinical Research Center of Hubei Province, Wuhan, China
| | - Qian Liu
- grid.412632.00000 0004 1758 2270Dept. of Reproductive center, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuchang District, 430060 Wuhan, China ,Assisted Reproduction and Embryogenesis Clinical Research Center of Hubei Province, Wuhan, China
| | - Xiaochen Wang
- grid.412632.00000 0004 1758 2270Dept. of Reproductive center, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuchang District, 430060 Wuhan, China ,Assisted Reproduction and Embryogenesis Clinical Research Center of Hubei Province, Wuhan, China
| | - Qingzhen Xie
- grid.412632.00000 0004 1758 2270Dept. of Reproductive center, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuchang District, 430060 Wuhan, China ,Assisted Reproduction and Embryogenesis Clinical Research Center of Hubei Province, Wuhan, China
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Zhang Y, Zhao W, Han Y, Chen X, Xu S, Hu Y, Diao H, Zhang C. The follicular-phase depot GnRH agonist protocol results in a higher live birth rate without discernible differences in luteal function and child health versus the daily mid-luteal GnRH agonist protocol: a single-centre, retrospective, propensity score matched cohort study. Reprod Biol Endocrinol 2022; 20:140. [PMID: 36123706 PMCID: PMC9483542 DOI: 10.1186/s12958-022-01014-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 09/10/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The gonadotropin-releasing hormone agonist (GnRH-a) has been used in in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles for a long time. This paper evaluates the efficacy and safety of two commonly used protocols (follicular-phase depot GnRH-a protocol and daily mid-luteal long GnRH-a protocol) in normal responders undergoing IVF/ICSI using propensity score matching (PSM) analysis. METHODS A total of 6,816 infertile women treated within the period from January 2016 to September 2020 were stratified into cohorts. A total of 2,851 patients received the long-acting group (depot GnRH-a protocol), and 1,193 used the short-acting group (long GnRH-a protocol) after the data-selection process. PSM was utilized for sampling by up to 1:1 nearest neighbour matching to adjust the numerical difference and balance the confounders between groups. The primary outcome was the live birth rate (LBR). Multivariable logistic analysis was used to evaluate the difference between these two protocols in relation to the LBR. RESULT(S) In this study, 1:1 propensity score matching was performed to create a perfect match of 964 patients in each group. After matching, the blastocyst formation rates, oestradiol (E2) value on Day hCG + 9, progesterone (P) value on Day hCG + 9, implantation rates, clinical pregnancy rates, and LBR were more favourable in the depot GnRH-a protocol than in the long GnRH-a protocol (P < 0.05). However, the moderate or severe OHSS rates were higher in the depot group than in the long group (P < 0.001). There were no significant differences in endometrial thickness, luteal support medication, early pregnancy loss rates, mid- and late-term pregnancy loss rates, or foetal malformation rates between the two protocols. CONCLUSION(S) Compared with the daily short-acting GnRH agonist protocol, the follicular-phase depot GnRH-a protocol might improve LBRs in normogonadotropic women without discernible differences in luteal function and child health.
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Affiliation(s)
- Ying Zhang
- grid.443573.20000 0004 1799 2448Reproductive Medicine Center, Renmin Hospital, Hubei University of Medicine, Shiyan, People’s Republic of China
- Hubei Clinical Research Center for Reproductive Medicine, Shiyan, People’s Republic of China
- grid.443573.20000 0004 1799 2448Biomedical Engineering College, Hubei University of Medicine, Shiyan, People’s Republic of China
- grid.443573.20000 0004 1799 2448Biomedical Research Institute, Hubei University of Medicine, Shiyan, People’s Republic of China
- grid.443573.20000 0004 1799 2448Hubei Key Laboratory of Embryonic Stem Cell Research, Hubei University of Medicine, Shiyan, People’s Republic of China
| | - Wenxian Zhao
- grid.443573.20000 0004 1799 2448Reproductive Medicine Center, Renmin Hospital, Hubei University of Medicine, Shiyan, People’s Republic of China
- Hubei Clinical Research Center for Reproductive Medicine, Shiyan, People’s Republic of China
| | - Yifan Han
- grid.443573.20000 0004 1799 2448Reproductive Medicine Center, Renmin Hospital, Hubei University of Medicine, Shiyan, People’s Republic of China
- Hubei Clinical Research Center for Reproductive Medicine, Shiyan, People’s Republic of China
- grid.443573.20000 0004 1799 2448Biomedical Engineering College, Hubei University of Medicine, Shiyan, People’s Republic of China
- grid.443573.20000 0004 1799 2448Biomedical Research Institute, Hubei University of Medicine, Shiyan, People’s Republic of China
- grid.443573.20000 0004 1799 2448Hubei Key Laboratory of Embryonic Stem Cell Research, Hubei University of Medicine, Shiyan, People’s Republic of China
| | - Xin Chen
- grid.443573.20000 0004 1799 2448Reproductive Medicine Center, Renmin Hospital, Hubei University of Medicine, Shiyan, People’s Republic of China
- Hubei Clinical Research Center for Reproductive Medicine, Shiyan, People’s Republic of China
- grid.443573.20000 0004 1799 2448Biomedical Engineering College, Hubei University of Medicine, Shiyan, People’s Republic of China
- grid.443573.20000 0004 1799 2448Biomedical Research Institute, Hubei University of Medicine, Shiyan, People’s Republic of China
- grid.443573.20000 0004 1799 2448Hubei Key Laboratory of Embryonic Stem Cell Research, Hubei University of Medicine, Shiyan, People’s Republic of China
| | - Shaoyuan Xu
- grid.443573.20000 0004 1799 2448Reproductive Medicine Center, Renmin Hospital, Hubei University of Medicine, Shiyan, People’s Republic of China
- Hubei Clinical Research Center for Reproductive Medicine, Shiyan, People’s Republic of China
- grid.443573.20000 0004 1799 2448Biomedical Engineering College, Hubei University of Medicine, Shiyan, People’s Republic of China
- grid.443573.20000 0004 1799 2448Biomedical Research Institute, Hubei University of Medicine, Shiyan, People’s Republic of China
- grid.443573.20000 0004 1799 2448Hubei Key Laboratory of Embryonic Stem Cell Research, Hubei University of Medicine, Shiyan, People’s Republic of China
| | - Yueyue Hu
- grid.443573.20000 0004 1799 2448Reproductive Medicine Center, Renmin Hospital, Hubei University of Medicine, Shiyan, People’s Republic of China
- Hubei Clinical Research Center for Reproductive Medicine, Shiyan, People’s Republic of China
- grid.443573.20000 0004 1799 2448Biomedical Engineering College, Hubei University of Medicine, Shiyan, People’s Republic of China
- grid.443573.20000 0004 1799 2448Biomedical Research Institute, Hubei University of Medicine, Shiyan, People’s Republic of China
- grid.443573.20000 0004 1799 2448Hubei Key Laboratory of Embryonic Stem Cell Research, Hubei University of Medicine, Shiyan, People’s Republic of China
| | - Honglu Diao
- grid.443573.20000 0004 1799 2448Reproductive Medicine Center, Renmin Hospital, Hubei University of Medicine, Shiyan, People’s Republic of China
- Hubei Clinical Research Center for Reproductive Medicine, Shiyan, People’s Republic of China
- grid.443573.20000 0004 1799 2448Biomedical Engineering College, Hubei University of Medicine, Shiyan, People’s Republic of China
- grid.443573.20000 0004 1799 2448Biomedical Research Institute, Hubei University of Medicine, Shiyan, People’s Republic of China
- grid.443573.20000 0004 1799 2448Hubei Key Laboratory of Embryonic Stem Cell Research, Hubei University of Medicine, Shiyan, People’s Republic of China
| | - Changjun Zhang
- grid.443573.20000 0004 1799 2448Reproductive Medicine Center, Renmin Hospital, Hubei University of Medicine, Shiyan, People’s Republic of China
- Hubei Clinical Research Center for Reproductive Medicine, Shiyan, People’s Republic of China
- grid.443573.20000 0004 1799 2448Biomedical Engineering College, Hubei University of Medicine, Shiyan, People’s Republic of China
- grid.443573.20000 0004 1799 2448Biomedical Research Institute, Hubei University of Medicine, Shiyan, People’s Republic of China
- grid.443573.20000 0004 1799 2448Hubei Key Laboratory of Embryonic Stem Cell Research, Hubei University of Medicine, Shiyan, People’s Republic of China
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