Live Birth Outcomes for PCOS Patients Under the Follicular-Phase Long-Acting GnRH Agonist Protocol or Antagonist Protocol – A Retrospective Chinese Cohort

Abstract

Objective

For patients with polycystic ovary syndrome (PCOS) to undergo in vitro fertilization (IVF) and embryo transfer (ET), there has been no consensus regarding which protocol is the most optimal for live birth rate in fresh cycles. We sought to evaluate depot gonadotropin-releasing hormone (GnRH) agonist protocol versus GnRH antagonist protocol in IVF outcomes for PCOS patients in a single fertility center.

Methods

In this retrospective cohort, PCOS patients who visited the Second Hospital of Hebei Medical University reproductive center between February 2012 and December 2019 were screened, and 533 PCOS infertility patients were included undergoing their first IVF cycle, with 470 in the depot GnRH agonist group and 63 in the GnRH antagonist group. The primary of this study outcome was the fresh live birth rate (LBR).

Results

PCOS women in the depot GnRH agonist group had a higher LBR (49.79%) than those in the GnRH antagonist group (34.92%, p = 0.027). The multivariable logistic regression also confirmed that women in the depot GnRH agonist group had a higher LBR than those in the GnRH antagonist group (OR = 1.83, 95% CI 1.05~3.18, p = 0.032). After propensity score matching (PSM), the LBR in the depot GnRH agonist group was higher (50.32%) than that of the GnRH antagonist group (35.48%), p = 0.033. The ovarian hyperstimulation syndrome (OHSS) rates were similar between the two groups, with 35 in the depot GnRH group and 6 in the GnRH antagonist group (p = 0.561).

Conclusions

For PCOS patients in fresh embryo transfer cycles, the depot GnRH agonist protocol may lead to a higher LBR than the antagonist protocol with satisfied lower OHSS rates.

Keywords:

• PCOS
• depot gonadotropin-releasing hormone agonist protocol
• gonadotropin-releasing hormone antagonist protocol
• cumulative live birth rate
• live birth rate

Data Sharing Statement

The datasets presented in this article are not readily available because of Chinese regulations and conditions for informed consent. Requests to access the dataset should be directed to Jiajia Zhai, [email protected].

Ethics Approval and Consent to Participate

As a retrospective analysis, this study cannot get registration before patients recruitment. But we affirm that this research study has been conducted in strict adherence to the principles delineated in the Declaration of Helsinki. The study analyzed the data of fresh embryo transfer (ET) cycles performed at the reproductive center of the Second Hospital of Hebei Medical University between February 2012 and December 20191. As a retrospective research, informed consents were not obtained from patients prior to this study. The ethical committee approved this work of the Second Hospital of Hebei Medical University (Approval number: 2021-P042). All subjects signed their informed consents before treatments. All methods were performed by the relevant guidelines and regulations.

Disclosure

The authors declare no conflicts of interest in this work.

Additional information

Funding

This study was supported by the Natural Science Foundation of Hebei Province (Beijing-Tianjin-Hebei Cooperation Special Project) under Grant (H2019206707), the S&T Program of Hebei under Grant (20377714D), the Medical Science Research Project of Hebei Province under Grant (20211494).