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| Study of the propensity score matching of the influence of modified long-acting GnRH agonist protocol on the live-birth outcomes of patients with decreased ovarian reserve |
| 73rd Hospital of PLA，Xiamen，Fujian Province, 361000 |
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Abstract To evaluate the clinical effect of modified long-acting GnRH agonist protocol during in vitro fertilization-embryo transfer (IVF-ET)/intracytoplasmic sperm injection (ICSI) of the patients with decreased ovarian reserve (DOR). Methods: 2299 patients with DOR who had undergone IVF /ICSI from July 2016 to December 2020 were analyzed retrospectively, which included the patients with modified long-acting GnRH agonist protocol treatment in group A and the patients with antagonist treatment in group B. The age，the duration of infertility，the value of body mass index (BMI)，the level of baseline follicle-stimulating hormone (FSH)，the antral follicle count (AFC), and the level of anti-Mullerian hormone (AMH) of the patients were included in matching variables, and 1:1 propensity score matching（PSM) was used to matching the basic information of the patient in the two groups (only 595 cases in each group in the end). The situation of ovulation induction, the laboratory data values, and the clinical outcomes of the patient were compared between the two groups. Logistic multifactor regression analysis was used to analyze the influence of different ovarian stimulation protocols of the patients on their live birth rate in each fresh transplantation cycle. Results: The starting dose of reduction gonadotropin (Gn) of the patients in group A was significantly lower than that of the patients in group B, and the days of Gn used, the total dose of Gn used, the thickness of endometrium on the day of human chorionic gonadotropin (hCG) used, the number egg obtained, the number of mature egg, the number of available embryos, the number of high quality embryo, the rate of blastocyst transplantation, the clinical pregnancy rate, and the live birth rate of each fresh transplantation cycle of the patients in group A were significantly higher than those of the patients in group B (P<0.05). There were no significant differences in the number of transplanted embryos and the abortion rate during the first trimester of pregnancy of the patients between the two groups (P>0.05). Multivariate regression analysis showed that the age, the ovarian stimulation protocol, the number of high-quality embryo, and the number of transplantation embryos of the patients were the independent factors affecting their live birth rate in each fresh transplantation cycle (P<0.05). The live birth rate of the patients in group A was significantly higher than that of the patients in group B (OR=2.154, 95%CI 1.489-3.116). Conclusion: Modified long-acting GnRH agonist protocol can improve the live-birth rate of fresh embryo transplantation of the patients with DOR, which can be used as one of their ovarian stimulation regimen options.
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