Comparison of cumulative live birth rates per oocyte retrieval cycle in patients with normal ovarian reserve function treated with PPOS and GnRH agonist long protocol
Objective To compare the cumulative live birth rates per oocyte retrieval cycle in patients with normal ovarian response between the gonadotropin-releasing hormone agonist(GnRH-a)long protocol and the progestin-primed ovarian stimulation(PPOS)protocol.Methods A retrospective cohort study was conducted in Centre of Assisted Reproduction,Shanghai First Maternity and Infant Hospital,Tongji University School of Medicine between January 2017 and December 2019.Women who underwent in vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI)treatment with normal ovarian reserve and<40 years of age were included.Other inclusion criteria included regular menstrual cycles,serum follicle-stimulating hormone level<10 U/L,and the antral follicle count>5.The primary outcome was the cumulative live birth rate(CLBR)within 18 months from the start of ovarian stimulation.Results A total of 995 patients were included in the study,with 509 patients in the PPOS group and 486 patients in the GnRH-a long group.Both groups had almost comparable demographic and cycle stimulation characteristics except for duration of infertility which was shorter in the PPOS group[3(2,4)years]than in the GnRH-a long group[3(2,5)years,P=0.015].In the GnRH-a long group,372 patients(77%)underwent fresh embryo transfer,resulting in 218 clinical pregnancies and 197 live births.The clinical pregnancy rate,the ongoing pregnancy rate,and the live birth rate per embryo transfer cycle were 58.6%(218/372),54.0%(201/372)and 53.0%(197/372),respectively.No fresh embryo transfer was performed in the PPOS group.During the study period,there were 662 frozen-thawed embryo transfer(FET)cycles in the PPOS group and 257 FET cycles in the GnRH-a long group.The PPOS group had a live birth rate of 31.1%(206/662)per FET cycle,which was notably lower than the GnRH-a long group[42.8%(110/257),OR=0.727;95%CI:0.607-0.871;P<0.001].The implantation rate of all FET cycles in the PPOS group was also lower than that in the GnRH-a long group[29.2%(293/1 004)vs.34.5%(157/455),OR=0.846,95%CI:0.721-0.992;P=0.041].CLBRs after one complete IVF/ICSI cycle including fresh and subsequent FET cycles within 18 months follow up were significantly lower in the PPOS group[40.5%(206/509)]than in the long agonist group[63.2%(307/486),OR=0.641,95%CI:0.565-0.726].Compared with the PPOS group,the GnRH-a long group had a significantly shorter duration from the start of ovarian stimulation to pregnancy and live birth(P<0.001).In Kaplan-Meier analysis,the CLBR was significantly higher in the GnRH-a long group than in the PPOS group(long rank test,P<0.001).Adjusted Cox-regression analysis revealed stimulation protocol adopted was strongly associated with the CLBR(OR=1.917,95%CI:1.152-3.190,P=0.012).Conclusion Progestin primed ovarian stimulation was associated with a lower cumulative live birth rates and a long time to pregnancy/live birth than the long agonist protocol in women with a normal ovarian reserve.
Fertilization in vitroEmbryo transferProgestin-primed ovarian stimulationGonadotropin-releasing hormone agonist long protocolCumulative live birth rate
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