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

Figures & data

Table 1 Baseline Characteristics for All 533 Subjects

		Depot GnRH Agonist Group (n=470)	GnRH Antagonist Group (N=63)	t or z or χ^2	p-value
Female age (years)	Mean(SD)	28.12(3.18)	28.06(3.35)	t= −0.1247	0.901
Spouse age (years)	Mean(SD)	28.83(3.42)	28.95(3.67)	t=0.2650	0.791
Duration of infertility (years)	Mean(SD)	4.23(2.51)	4.00(2.50)	z= −0.739	0.460
	Median (IQR)	4(2–5)	4(2–5)
Natural cycle (%)	Nature cycle	464(98.7)	61(96.8)		0.242
	Others	6(1.3)	2(3.2)
BMI (kg/m^2)	Mean(SD)	25.97(3.87)	26.11(3.96)	t=0.2794	0.780
Baseline FSH (mIU/mL)	Mean(SD)	6.71(1.82)	6.77(1.93)	t=0.2287	0.819
Baseline E2 (pg/mL)	Mean(SD)	64.88(63.80)	45.21(34.70)	z= −2.258	0.024
	Median (IQR)	43(30–73.40)	41(23–55)
Baseline P (ng/mL)	Mean(SD)	1.43(3.38)	0.82(1.11)	z= −2.695	0.007
	Median (IQR)	0.71(0.44–1.33)	0.60(0.35–0.85)
Baseline PRL (ng/mL)	Mean(SD)	13.49(8.58)	13.51(10.05)	z=0.078	0.938
	Median (IQR)	11.66(8.62–15.82)	11.73(9.07–15.83)
Baseline LH (mIU/mL)	Mean(SD)	9.36(6.52)	9.33(10.06)	z= −0.895	0.371
	Median (IQR)	7.39(4.82–12.73)	7.04(4.89–10.32)
Baseline T (ng/mL)	Mean(SD)	0.94(1.14)	0.65(0.28)	z= −1.634	0.102
	Median (IQR)	0.67(0.47–0.96)	0.61(0.45–0.78)
AFC total	Mean(SD)	22.67(3.37)	22.11(4.92)	t= −1.1576	0.248
Endometrium thickness on hCG day (mm)	Mean(SD)	11.24(1.74)	10.86(1.80)	t= −1.6266	0.104

Abbreviations: SD, standard deviation; IQR, the interval of quartile range (Q1-Q3).

Figure 1 Patients recruiting flow diagram, according to treatment groups.

Table 2 ART Outcomes for All 533 Subjects

		Depot GnRH Agonist Group (n=470)	GnRH Antagonist Group (N=63)	t or z or χ^2	p-value
Gn total dose	Mean(SD)	2717.10(1198.34)	2300.71(1372.14)	t= −2.5441	0.011
	Median (IQR)	2475(1806.25–3300)	1800(1575–2700)	z= −3.627	<0.001
Number of oocytes retrieved	Mean(SD)	12.15(5.13)	12.13(5.25)	t= −0.038	0.970
	Median (IQR)	12(8–16)	11(8–16)	z= −0.190	0.849
Clinical pregnancy rate	Yes	277 (58.94%)	37 (58.73%)	χ^2= 0.0010	0.975
	No	193 (41.06%)	26 (41.27%)
LBR	Yes	234 (49.79%)	22 (34.92%)	χ^2=4.919	0.027
	No	236 (50.21%)	41 (65.08%)
OHSS	Yes	35 (7.4%)	6 (8.5%)	χ^2=0.340	0.561
	No	435 (92.6%)	57 (90.5%)

Abbreviations: ART, assisted reproductive technology; SD, standard deviation; IQR, the interval of quartile range (Q1-Q3); LBR, live birth rate; OHSS, ovarian hyperstimulation syndrome.

Table 3 Single Factor Analysis and Logistic Regression for Fresh Cycle for All 533 Subjects

		Univariate Analysis		Multivariate Logistic Regression Analysis
	n (%)	OR (95% CI)	P	OR (95% CI)	P
Female age (>35 years)	8(1.50)	0.15(0.02, 1.24)	0.0783	0.15(0.02, 1.28)	0.084
Infertility type (Secondary infertility)	6(1.13)	5.50(0.64, 47.38)	0.1209	4.82(0.56, 41.86)	0.154
BMI (>24 kg/m^2)	356(66.79)	1.23(0.85, 1.76)	0.2686
Duration of infertility (>3 years)	285 (53.47)	0.86(0.61, 1.21)	0.3959
Natural cycle(others)	8 (1.50)	0.65(0.15, 2.73)	0.5511
AFC total (>22)	389 (72.98)	1.37(0.93, 2.01)	0.1116
Gn total dose (>2900IU)	178(33.40)	0.75(0.52, 1.08)	0.1189
Baseline FSH (>8.78 mIU/mL)	58(10.88)	0.68(0.39, 1.19)	0.1782
Baseline E2(>40 pg/mL)	291(54.60)	0.92(0.65, 1.29)	0.6299
Baseline P (>1.52 ng/mL)	102(19.14)	0.91(0.59, 1.40)	0.6609
Baseline PRL (>26.7 ng/mL)	31(5.82)	1.34(0.64, 2.77)	0.4356	1.28(0.61, 2.70)	0.512
Baseline LH (Baseline LH -Baseline FSH>0 mIU/mL)	313(58.72)	0.85(0.60, 1.20)	0.3477
Baseline T (>0.75 ng/mL)	190(35.65)	0.87(0.61, 1.24)	0.4411
Endometrium thickness on hCG day (>14 millimeters)	25(4.69)	1.18(0.53, 2.64)	0.6843
Treatment protocol (Depot GnRHa)	470(88.18)	1.85(1.07, 3.20)	0.0283	1.83(1.05, 3.18)	0.032
Number of oocytes retrieved
Group 1 (0–5)	50(9.38)	Ref.
Group 2 (6–10)	161 (30.21%)	1.21(0.64, 2.31)	0.5568	1.20(0.63, 2.32)	0.578
Group 3 (11–15)	178 (33.40%)	1.60(0.85, 3.04)	0.1460	1.50(0.79, 2.86)	0.218
Group 4 (16 above)	144 (27.02%)	1.50(0.78, 2.88)	0.2238	1.43(0.74, 2.77)	0.292

Figure 2 Multivariable logistic regression showed the depot GnRH agonist group had a higher LBR than those in the GnRH antagonist group.

Figure 3 Relationship between the endometrial thickness (EMT) and the probability of LBR. Restricted cubic spline curve of the relationship between EMT and the probability of LBR, adjusted age; infertility type; duration of infertility; natural cycle; BMI; baseline FSH, E2, P, PRL, LH, T, and AFC; whether LH was added; total dose of Gn; and the number of oocytes retrieved.

Table 4 Baseline Characteristics for 372 PSM Subjects

		Depot GnRH Agonist Group (n=310)	GnRH Antagonist Group (n=62)	p-value	SMD
Female age	Mean(SD)	28.12(3.12)	28.11(3.35)	0.994	0.001
Spouse age (years)	Mean(SD)	28.90(3.26)	29.05(3.62)	0.754	0.042
Duration of infertility (years)	Mean(SD)	4.23(2.56)	4.05(2.49)	0.617	0.070
Natural cycle (%)	Nature cycle	304(98.1)	61(98.4)	1.000	0.024
	Others	6(1.9)	1(1.6)
BMI (kg/m^2)	Mean(SD)	26.00(3.81)	26.16(3.97)	0.765	0.041
Baseline FSH (mIU/mL)	Mean(SD)	6.66(1.72)	6.79(1.93)	0.601	0.070
Baseline E2 (pg/mL)	Mean(SD)	42.11(23.56)	45.10(34.98)	0.404	0.101
Baseline P (ng/mL)	Mean(SD)	0.73(0.55)	0.82(1.12)	0.316	0.107
Baseline PRL (ng/mL)	Mean(SD)	13.25(8.53)	13.51(10.13)	0.827	0.029
Baseline LH (mIU/mL)	Mean(SD)	9.25(6.65)	9.24(10.11)	0.986	0.002
Baseline T (ng/mL)	Mean(SD)	0.61(0.28)	0.65(0.28)	0.330	0.135
AFC total	Mean(SD)	22.28(3.73)	22.08(4.95)	0.717	0.046
Endometrium thickness on hCG day (mm)	Mean(SD)	11.08(1.64)	10.85(1.82)	0.336	0.129

Abbreviations: SD, standard deviation; SMD, standard mean difference.

Table 5 ART Outcomes for 372 PSM Subjects

		Depot GnRH Agonist Group (n=310)	GnRH Antagonist Group (n=62)	t or χ^2	p-value
Number of oocytes retrieved	Mean(SD)	11.90 (5.05)	12.19 (5.27)	0.411	0.682
Fresh Live Birth Rate	No	154 (49.7)	40 (64.5)	4.559	0.033
	Yes	156 (50.3)	22 (35.5)
Clinical Pregnancy Rate	No	128 (41.3)	25 (40.3)	0.020	0.888
	Yes	182 (58.7)	37 (59.7)

Abbreviations: ART, assisted reproductive technology; SD, standard deviation; IQR, the interval of quartile range (Q1-Q3); LBR, live birth rate; OHSS, ovarian hyperstimulation syndrome.

Table 6 Live Birth Rate of Fresh Cycle for PSM Subjects

	OR (95% CI)	Std. Error	P-value
Treatment protocol
Depot GnRH Agonist vs GnRH Antagonist
	1.84 (1.05, 3.24)	0.29	0.034

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].