Comparison Of Cumulative Live Birth Rates Using Different Controlled Ovarian Stimulation Regimens In Population With Diminished Ovarian Reserve

BackgroundOvarian reserve is used to assess primordial follicles in the ovary and is reflected by the number of growing follicles.Serum anti-Müllerian hormone(AMH)can be used as a marker for growing follicles,is known as the best indicator of ovarian reserve because of the lack of a direct serum marker for primordial follicles.Diminished ovarian reserve(DOR)is a description of the status of ovarian reserve,and its diagnostic criteria are controversial.In recent years,the number of patients with diminished ovarian reserve has increased with the increase of the number of people applying assisted reproductive technology(ART).Several studies have shown that DOR was associated with decreased quantity and quality of oocytes,and adverse in vitro fertilization(IVF)outcomes,including lower clinical pregnancy rates and live birth rates,and higher abortion rates.To compare the cumulative live birth rates(CLBRs)of populations showing a diminished ovarian reserve and non-diminished ovarian reserve and to choose suitable controlled ovarian stimulation(COS)regimes for the diminished ovarian reserve population,we designed the study.MethodsThis was a retrospective cohort study that included women who had completed their first oocyte retrieval and conventional IVF cycle from the Reproductive Hospital Affiliated to Shandong University between 1 January 2017 and 31 December 2019.Patients with an AMH level of<1.1ng/ml were diagnosed as DOR.A total of 9,462 patients were included in this study,of which 1,699 were diagnosed as DOR.Of this DOR population,1,581 were assigned to a DOR group and another 1,581 patients were assigned to a non-DOR group by propensity score matching(PSM)using SPSS 22.0.All 1,699 DOR patients were assigned to five different subgroups,according to the COS regimens used,in order to compare CLBRs.Results1.In the DOR compared to non-DOR group,the DOR group showed a decreased number of retrieved oocytes([4.90±2.93]vs[7.64± 4.00],P<0.001)and oocyte retrieval rate([100.66± 37.94%]vs[(104.48 ± 37.17%],P=0.004).For fresh transfer cycles,the DOR group showed fewer biochemical pregnancies(50.09%vs 56.88%;P=0.001),and lower implantation rate(34.33%vs 39.04%;P=0.003),lower clinical pregnancy rate(42.25%vs 50.41%;P<0.001),and lower live birth rate(33.96%vs 40.88%;P=0.001).The DOR group underwent fewer fresh or frozen embryo transfer cycles([1.05 ± 0.68]vs[1.29 ± 0.78],P<0.001)and fewer embryos were transferred([1.47±0.95]vs[1.81±1.03],P<0.001).2.In the DOR compared to non-DOR group,the DOR group showed decreasing CLBRs(35.10%vs 53.19%;P<0.001).The overall trend was for decreased CLBRs with age in both DOR and non-DOR populations.In addition,the CLBRs of the DOR group were lower than those of the non-DOR group at all ages.3 Age,AMH,and COS regimes were associated with the CLBRs of DOR patients.Controlled ovarian stimulation regimes were relevant to CLBRs for DOR patients with AMH≥0.5ng/ml but not for DOR patients with AMH<0.5ng/ml.For DOR patients with AMH ≥ 0.5ng/ml,CLBRs were higher in the long gonadotropin-releasing hormone(GnRH)agonist protocol compared with other COS regimens.ConclusionFor all populations,the CLBRs in patients with DOR was significantly lower than non-DOR group.The long GnRH agonist protocol as COS regimen showed a higher cumulative live birth rates for a DOR population with greater ovarian reserve(AMH≥0.5ng/ml).