Comparison Of GnRH Agonist Versus GnRH Antagonist Protocols In The Coh Of PCOS Patients

Objective: Comparison of clinical outcome between GnRH agonist(GnRHa) protocols group versus GnRH antagonist (GnRHant) protocols groupin COH (IVF/ICSI) of PCOS patients, in order to provide the clinical basis datafor the COH protocol selection of patients with PCOS.Methods: Retrospective analysis was used in the PCOS patients whoutilized the IVF/ICSI treatment from January,2011to September,2013in theReproductive Medical Center of the Third Affiliated Hospital of GuangxiMedical University, which contained331cycles, including280GnRHaprotocols cycles and51cycles GnRHant protocols.The rate of clinical pregnancy in fresh cycle, incidence of OHSS,cumulative pregnancy, clinical pregnancy of FET cycles which includedcancelling fresh embryo ET group and no live birth after fresh embryotransplantation group were compared in two protocols. OOcyte maturationtriggered with GnRHa and HCG also ware compared. The ROC (receiveroperating characteristic curve) was used to analyze the predicting value and theoptimal diagnostic boundary value of the OHSS.Results:1. GnRHant group had lower Gn days, the dosage of Gn, Em thin on HCG day, number of oocytes retrieved, number of mature oocytes retrieved,number of frozen embryos, the pregnancy rate of fresh ET clinical wassignificant difference compared with GnRHa group. GnRHant group had alower incidence of OHSS and cumulative pregnancy rate, but no statisticaldifference between the two groups.2. In the no live birth after fresh embryo transplantation group, the D3andthe D6FET clinical pregnancy rate of the GnRHant group was lower (25%vs33.3%P=1;30%vs50%P=0.446). The cumulative pregnancy rate, theGnRHant group was lower than the GnRHa group (42.1%vs64.2%P=0.011).In the cancelling fresh ET group, the D3and the D6FET clinical pregnancy rateof the GnRHant group was higher (66.7%vs54%P=0.682；80%vs53.4%P=0.084). The cumulative pregnancy rate, the GnRHant group was higher thanthe GnRHa group, there was statistically significant difference (100%vs65.6%P=0.009).3. In the COH treatment of PCOS patients who choice GnRHant protocol,GnRHa triggered oocyte maturation compared with HCG no difference inpregnancy rate (20%VS27.3%P=0.615), decreased incidence of OHSS (0%VS6.8%P=1).4. ROC curves to predict the incidence rate of OHSS, when the number ofretrieved oocytes is more than21, the sensitivity was34.4%, the specificity was84.8%. When HCG days’ estrogen was more than2653.5pg/ml, the sensitivitywas96.9%, the specificity was35.8%.Conclusions:1. In the COH treatment of PCOS patients, the GnRHa protocol has ahigher fresh clinical pregnancy rate per cycle than the GnRHant protocol.GnRHant protocol has a shorter Gn treatment duration and the lower Gn requirement, and likely to decrease endometrial receptivity, so has a lower freshclinical pregnancy rate per cycle. But the two protocols had similar cumulativepregnancy rate, so we can have a flexible selection to choose COH protocolaccording to the PCOS patients’ state.2. In the COH treatment of PCOS patients who choose GnRHant protocol,freezing the total embryos, selective to FET can improve clinical cumulativepregnancy rate.3. PCOS patients choose GnRHant protocol and (or) triggering withGnRHa likely can decrease the incidence of OHSS.4. When estrogen was more than2653.5pg/ml on the HCG days and morethan21oocytes retrieved, it has a relative high value to predict the incidence ofOHSS.