Comparison of the early follicular long-term protocol and antagonist protocol in Obese infertility patients
Objective:To investigate the clinical effects and pregnancy outcomes of the early follicular long-term protocol and antagonist protocol in the treatment of obese infertility patients.Methods:This study was a retrospective cohort study.The data of patients with body mass index(BMI)≥30 kg/m2 who underwent in vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI)in Northwest Women and Children's Hospital from January 2021 to December 2022 were collected.According to the different ovulation induction schemes,they were divided into two groups:long-term ovulation scheme group(n=170)and antagonist scheme group(n=374).The basic characteristics,ovulation induction and fresh cycle transplantation were compared between the two groups,and the main factors for pregnancy outcome such as age,BMI,polycystic ovary syndrome(PCOS),transfer of high-quality embryos,transfer of high-quality blastocysts and ovulation-stimulating protocol were evaluated by logistic multivariate analysis.Results:The patients in the antagonist group were older,less in primary infertility,shorter in infertility years,higher in basic follicle-stimulating hormone(bFSH),less in ovulation induction in the first cycle,less in combined with PCOS and insulin resistance,shorter in days of gonadotropin(Gn)use,less in the number of oocyte obtained,less in available embryos and less in ovarian hyperstimulation syndrome(OHSS)incidence,and the differences were statistically significant(P＜0.05).There were no significant differences between the two groups in BMI,antral follicle count(AFC)and the prevalence of type Ⅱdiabetes,total Gn doses,levels of estradiol(E2)and progesterone(P)as well as endometrial thickness on humanchorionic gonadotropin(hCG)day,the number of high-quality embryos,the rate of unavailable transferred embryos,the number of transferred embryos in fresh cycle,and the proportion of transferred blastocysts(P＞0.05).There were no significant differences in pregnancy outcomes and neonatal outcomes between the two groups(P＞0.05).After adjusting for age,BMI,combining with PCOS and other related confounding factors,the statistical results showed that the age was an independent factor for live birth rate(P＜0.05),and different ovulation induction schemes did not affect live birth rate in the fresh cycle,the incidence of gestational diabetes mellitus and hypertensive disorders.Conclusions:Similar clinical pregnancy outcomes can be achieved with follicular long-term protocol and antagonist protocol in infertile patients with obesity.Compared with the follicular long-term protocol,the antagonist protocol can shorten the duration of Gn use.Therefore,infertility patients with obesity can give priority to the antagonist plan for ovulation induction.However,considering the increased risk of perinatal adverse events in obese patients after subsequent pregnancy,attention should still be paid to controlling BMI in patients undergoing IVF/ICSI treatment in clinical practice.
Follicular long-term protocolAntagonist protocolBody mass indexIVF/ICSIPregnancy outcomes
万方数据
维普
