Comparison Of The Outcome Of Three Ovarian Stimulation Regimens For Patients With Low Ovarian Reserve Undergoing IVF

Objective: To compare the efficacy of minimal stimulation, GnRH- antagonist regimen, and GnRHa flare-up regimen for patients with low ovarian reserve that underwent ovarian stimulation for IVF-ET, and find the best ovarian stimulation regimen for this kind of patients.Methods: Retrospectively analyzed 174 patients who were diagnosed with low ovarian reserve and underwent IVF in the ART Department of the Second Hospital of Hebei Medical University from August 2010 to February 2011. According to the ovarian stimulation regimen, the patients were divided into three groups, minimal stimulation (group A), GnRH-antagonist regimen (group B), flare-up regimen (group C). Compared the age, BMI, infertility duration, bFSH level, bLH level, bE₂ level, rate of infertility factors among the three groups; Gn comsumptions, duration of Gn, the E₂ level and the thickness of endometrium on the day maturation was trriggered; number of oocyes obtained and high-quality embryos, rate of high-quality embryos, the average number of embryos transferred; rate of pregnancy, rate of implantation and early pregnancy loss.Results: There were no significant differences in the terms of age, BMI, duration of infertility, bFSH level, bLH level, bE₂ level, rate of infertiliry factors among the three groups; Gn consumptions was significantly different among the three groups, group A2 level on the day maturation was trriggered in group A and B was similar(1267.7±737.0 vs 1164.0±713.1pg/ml, P > 0.05), both were lower than group C (2081.4±1215.3pg/ml); The thickness of the endometrium on the day of maturation was triggered in group A was much lower than in the other two groups; the number of oocytes obtained in the three groups were 4.6±2.5, 4.5±2.8, 5.4±3.0 repectively, group A and B were fewer than group C, but failed to reach statistics difference; the number of high-quality embryos and average embryos transferred were all similar among the three groups; the rate of high-quality embryos in group A was 60.2%, which was much higher than the other two groups (52.7% vs 49.1%,respectively); the rate of implantation in group A and B was similar (24.4% vs 26.3%, P>0.05), both was much higher than group C (18.3%); the clinical pregnancy rate in group A and B was similar (47.3% vs 46.8%,P>0.05), both were much higher than the group C (31.6%); the early pregnancy loss was similar among the three groups.Conclusions:For the patients with low ovarian reserve, they underwent IVF-ET, using the minimal stimulation; GnRH-antagonist regimen and flare-up regimen for ovarian stimulation were similar in the terms of number of oocytes obtained, high-quality embryos and early pregnancy loss. The rate of implantion and clincal pregnacy in the minimal stimulation regimen and GnRH-antagonist regimen was much higher than the flare-up regimen. Compared with the GnRH-antagonist regimen and flare-up regimen the minimal stimulation was much greater in terms of rate of high-quality embryos, but much lower Gn consumptions. The minimal stimulation seems to be the most economic and effective regimen for the patients who have low ovarian reserve.