| Objective:To compare the cumulative live birth rate between early-follicular-phase single-dose long-acting gonadotropin-releasing hormone(Gn RH)agonist protocol and Gn RH antagonist flexible protocol in normal responders.Method: From January 2015 to march 2020,a total of 21773 in vitro fertilization /intracytoplasmic sperm injection(IVF/ICSI)cycles of 11140 infertile couples undergoing controlled ovarian stimulation(COS)with early-follicular-phase single dose Gn RH agonist protocol(4846 cycles of 3234 couples)or Gn RH antagonist flexible protocol(16927 cycles of 7906 couples)in the clinical reproductive medicine center of Jiangsu province hospital were retrospective analyzed.Exclude 226 couples(437 cycles)who have accepted IVF/ICSI treatment equal or greater than 3 times,the data of 10914 couples were matched using the female age,Body Mass Index(BMI),infertile years,follicle stimulating hormone(FSH),Luteinizing hormone(LH),Estradiol(E2),Anti-Mullerian hormone(AMH),Antral follicles count(AFC)in spss24.Finally,the early-follicular-phase single dose Gn RH agonist protocol group included 3051 couples and 4581 cycles,the Gn RH antagonist flexible protocol group included 3051 couples and 6256 cycles.In propensity matching,Balances in baseline variables using standardized differences were examined.Absolute values of <10% were considered balance.Therefore,create a treatment group with an approximate randomized effect and the bias of non-randomized treatment group was partially eliminated.The level of the duration of gonadotropin(Gn)stimulation,the total dosage of Gn were observed.The number of oocytes obtained,number of embryos transferred,Fresh embryo transplantation proportion,the rate of implantation,clinical pregnancy and live birth in the fresh embryo transfer cycle and the frozen embryo transfer cycle,ovarian hyperstimulation syndrome(OHSS)rates,cumulative live birth rates and the time to live birth were observed.Result: There were 6102 couples,including 4581 cycles in agonist group and 6256 cycles in the antagonist group in the study through propensity score matching.There was no significant difference in female age,BMI,infertile years,FSH,LH,E2,AMH,AFC between the two matched groups(P > 0.05).The duration of Gn stimulation(9.6±4.5 VS 7.6±3.0),and the total dosage of Gn(1502.3±955.2 VS 1169.4±725.5)were significantly higher in the agonist group than the antagonist group(P<0.0001).If the women were younger than 35,the number of oocytes obtained was no significant difference between the two groups(P>0.05).The agonist group obtained more oocytes than the antagonist group in women aged 35 or older(P<0.0001).The number of embryos transferred(1.2±0.4 VS 1.3±0.5)was lower in the agonist group than the antagonist group(P<0.0001).The proportion of fresh embryo transplantation(78.49% VS 48.64%)in the agonist group was higher than the antagonist group(P<0.0001).There was no significant difference in the OHSS rates in the two groups.In the fresh embryo(D3/4)transfer cycle:When the women were younger than 35,the rate of implantation,clinical pregnancy and live birth were significantly higher in the agonist group(P<0.0001).In women aged 35 or older,the rate of implantation,clinical pregnancy were higher in the agonist group,but there was no significant difference(P>0.05).However,the live birth rate(41.67%VS27.39%)was higher in the agonist group than the antagonist group(P<0.0001).In the fresh embryo(D5/6)transfer cycle:Although the implantation rate,clinical pregnancy rate and live birth rate were higher in the agonist group,there was on significant difference between the two groups.In the frozen embryo(D3/4)transfer cycle:Although the implantation rate,clinical pregnancy rate and live birth rate were lower in the agonist group than the antagonist group,there was no significant difference between the two groups(P>0.05).In the frozen embryo(D5/6)transfer cycle:The implantation rate,clinical pregnancy rate and live birth rate were lower in the agonist group than the antagonist group(P<0.05).After one ART cycles,including the fresh and frozen–thawed embryo transfer cycles were less than 5,the cumulative live birth rate was higher in the agonist group.The time to live birth is shorter in the agonist group than the antagonist group whatever from the day of controlled ovarian stimulation or the day of oocytes obtainment(P<0.0001).Conclusion: Compare with GnRH antagonist flexible protocol,the proportion of fresh embryo transplantation and cumulative live birth rate were increased and the time to live birth was shorter with the single dose Gn RH agonist protocol.When the patients had to cancel fresh embryo transfer for the high risk of OHSS,hydrosalpinx or endometrial polyp,the Gn RH antagonist flexible protocol can be selected,it can improve the rate of pregnancy in frozen embryo transfer cycle. |
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