GnRH antagonist versus follicular-phase single-dose GnRH agonist protocol in patients of normal ovarian responses during controlled ovarian stimulation

Abstract

Objective: This study aims to explore the differences of the ovarian stimulation (OS) characteristics, laboratory, and clinical outcomes between follicular-phase single-dose gonadotropin-releasing hormone (GnRH) agonist protocol and GnRH antagonist protocol during controlled ovarian hyperstimulation (COH).

Methods: About 1883 consecutive IVF/ICSI fresh cycles of normal ovarian responders were retrospectively analyzed, with 1229 in the single-dose GnRH agonist protocol group and 654 in the GnRH antagonist protocol group at Reproductive Medical Center of Tongji Hospital from 1 January 2014 to 31 December 2017.

Results: The follicular-phase single-dose GnRH agonist group showed significantly more oocytes obtained, higher implantation rate and pregnancy rate, as well as lower luteinizing hormone (LH) level and estradiol (E2)/oocyte ratio on the day of human chorionic gonadotropin (hCG) administration. However, differences were not significant in meiosis II (MII) oocyte rate, two pronuclear zygote (2PN) embryo rate, viable embryo rate or high-quality embryo rate, compared with the GnRH antagonist group. Further comparison of clinical outcomes in the first frozen-thawed cycles did not show significant difference in either implantation or clinical pregnancy rate between the two protocol groups.

Conclusions: Follicular-phase single-dose GnRH agonist protocol may achieve better clinical outcomes in normal ovarian responders, which could be explained more by positive effect on endometrial receptivity rather than embryo quality.

摘要：

目的：本研究旨在探讨在控制性卵巢过度刺激(COH)过程中用卵泡期单剂量促性腺激素释放激素(GnRH)激动剂方案和GnRH拮抗剂方案之间卵泡刺激(OS)特征, 实验室和临床结果的差异。

方法:回顾性分析了从2014年1月1日至2017年12月31日同济医院生殖医学中心大约1883例IVF/ICSI连续新鲜周期的正常卵巢反应者, 其中单剂量GnRH激动剂方案组1229例, GnRH拮抗剂方案组654例。

结果:卵泡期单剂量GnRH激动剂组在人绒毛膜促性腺激素(hCG)给药当天便显示卵母细胞明显增多, 获得较高的着床率和妊娠率, 黄体生成素(LH)水平和雌二醇(E2)/卵母细胞比值低。然而, 与GnRH拮抗组相比, 减数分裂II (MII)卵母细胞率、双原核受精卵(2PN)胚胎率、活胚率或优质胚率的差异不显著。进一步比较第一次冻融周期的临床结果, 两组方案之间的植入率和临床妊娠率均无显著差异。

结论:卵泡期单剂量GnRH激动剂方案在正常卵巢反应者中可取得较好的临床效果, 这可能更多地是由于其对子宫内膜容受性的积极影响, 而非胚胎质量。

The Chinese abstracts are translated by Prof. Dr. Xiangyan Ruan and her team: Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China.

Keywords:

• In vitro fertilization
• ovarian stimulation
• GnRH antagonist
• depot GnRH agonist
• clinical pregnancy

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the National Natural Science Foundation of China under Grant [No. 81401268].