Comparison of clinical outcomes of different recombinant LH supplementation in POSEIDON group 4 patients under GnRH antagonist protocol
Objective:To analyze the clinical effects of recombinant human luteinizing hormone(rLH)supplementation in IVF/ICSI among POSEIDON group 4 patients under the GnRH antagonist protocol.Methods:Data of 779 patients,who met the criteria of POSEIDON group 4 as poor ovarian response(POR)and underwent controlled ovarian hyperstimulation by GnRH antagonist protocol in Reproductive Medicine Center of People's Hospital of Wuhan University from January 2017 to December 2022 were retrospectively analyzed.According to the different rLH supplementation,the included participants were divided into four groups:control group(no rLH supplementation,n=481),early follicular phase supplementation group(rLH supplementation initiating on the first day of stimulation,n=116),GnRH antagonist day supplementation group(rLH supplementation initiating on GnRH antagonist day,n=100),and late follicular phase supplementation group(rLH supplementation initiating after eight days of stimulation,n=82).The basic characteristics,controlled ovarian stimulation,embryonic development and pregnancy outcomes of fresh embryo transfer cycles were compared among the four groups.Results:As for the baseline characteristics,no significant differences were found in age,infertility years,previous cycle number of 1VF/ICSI treatment,and infertility types among the four groups(P＞0.05).Regarding controlled ovarian stimulation,the gonadotropin(Gn)stimulation days and total Gn dosage were significantly lower in early follicular phase supplementation group,but significantly higher in late follicular phase supplementation group(P＜0.05)than that in the control group(P＜0.05).The duration of Gn stimulation was remarkably decreased in GnRH antagonist day supplementation group when compared with the control group(P＜0.05).The estradiol(E2)level on trigger day was significantly increased in GnRH antagonist day supplementation group when compared with the control group(P＜0.05),and the number of dominant follicles not less than 18 mm was higher in early follicular phase supplementation group(P＜0.05),and the endometrium thicknesses were lower in both early follicular phase and GnRH antagonist day supplementation groups(P＜0.05).As for embryonic laboratory outcomes,the numbers of retrieved oocyte,two pronuclei(2PN)oocyte,2PN cleavage rate,high-quality embryo on day 3,and available embryos in early follicular phase supplementation group were remarkably higher than those in the control group(P＜0.05)in both IVF and ICSI cycles.In IVF cycles,the numbers of retrieved oocyte,2PN oocyte and 2 PN cleavage rate in GnRH antagonist day supplementation group were significantly higher than those of the control group(P＜0.05).The fresh embryo transfer rate was remarkably higher in early follicular phase,GnRH antagonist day,and late follicular phase supplementation groups than that in control group(P＜0.05),and the cycle cancellation rate was significantly lower in early follicular phase and GnRH antagonist day supplementation groups than that of the control group(P＜0.05).Conclusions:For POR women with advanced maternal age and diminished ovarian reserve,early follicular phase supplementation of rLH can increase the numbers of retrieved oocyte,high-quality embryo on day 3,and available embryos,with declined cycle cancellation rate and more opportunities of embryo transfer.
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