We recruited 309 women with AMH < 1.2 ng/ml, including 145 PPOS protocols, 119 GnRH-Ant protocols and 45 GnRH-a protocols. There were no significant differences in the patients’ age, BMI, type of infertility, duration of infertility, doses and duration of Gn treatment, cycle cancellation rate, serum basal estradiol, LH and P levels, serum FSH and P values on trigger day, rate of 2PN fertilized oocytes, transplantable embryos, good-quality embryo, clinical pregnancy rate, live birth rate and miscarriage rate among the three groups. Patients in the GnRH-a group had the best ovarian reserve function of the three groups. When compared with PPOS group and GnRH-Ant group, the AMH value, AFC and oocytes retrieved were significantly higher in GnRH-a group (P = 0.021; P < 0.001; P < 0.001); the basal FSH value was significantly lower in GnRH-a group (P = 0.006); the estradiol values on trigger day and growth hormone utilization rate were significantly increased in GnRH-a group (P < 0.001; P = 0.001). However, there was no significant difference in the outcomes of embryos, without significant difference in 2PN rate, transplantable embryo rate and high-quality embryo rate among the three groups. There was also no significant difference in pregnancy outcomes, although the clinical pregnancy rate (61% vs.51.2% vs.44.9%) and live birth rate (33.3% vs.23.3% vs.23.2%) were higher in GnRH-a group than PPOS and GnRH-Ant groups, but not statistically significant. The chemical pregnancy rate was significantly higher in GnRH-a group than GnRH-Ant group (80.5% vs. 56.7%, P = 0.008). LH values on trigger day were significantly higher in GnRH-Ant group than the other two groups (P < 0.001). The cycle cancellation rate and miscarriage rate were highest in PPOS group, but without significant difference (Table 1).
Table 1
Basic characteristics, ovarian stimulation and embryo characteristics, pregnancy outcomes in three regimens
Parameter | PPOS (N = 145) | GnRH-Ant (N = 119) | GnRH-a (N = 45) | P |
Age (year) | 32 (30–33) | 31 (29–33) | 31 (30–33) | 0.296 |
Primary infertility n (%) | 73 (50.3%) | 59 (49.6%) | 27 (60.0%) | 0.46 |
Duration of infertility (year) | 3 (2–5) | 3 (2–4) | 3 (1-4.5) | 0.407 |
BMI (kg/m2) | 22 (20-23.95) | 20.8 (19.3–23.2) | 21.3 (19.2-22.85) | 0.068 |
AMH (ng/ml) | 0.72 (0.43–0.98) | 0.76 (0.52–0.97) | 0.85 (0.71–1.02)ab | 0.021; a 0.008; b 0.016 |
AFC | 7 (5–9) | 7 (5–10) | 11 (7.5–12)ab | < 0.001; a < 0.001; b < 0.001 |
Basal E2 (pg/ml) | 41.34 (32.19–55.65) | 45.76 (32.62–56.8) | 44.68 (35.93–55.34) | 0.468 |
Basal LH (mIU/ml) | 3.18 (2.46–4.28) | 3.38 (2.2–4.49) | 3.46 (2.35–4.65) | 0.774 |
Basal FSH (mIU/ml) | 9.66 (7.70-13.42) | 9.28 (7.40-12.13) | 8.09 (7.16–9.58)ab | 0.006; a 0.002; b 0.008 |
Basal P (ng/ml) | 0.59 (0.44–0.87) | 0.66 (0.50–0.89) | 0.55 (0.33–0.69) | 0.065; b 0.021 |
E2 values on trigger day (pg/ml) | 1313.79 (742.12-1763.96) | 1429.46 (907.61-2311.93) | 2516.55 (1279.48-3222.26)ab | < 0.001; a < 0.001; b < 0.001 |
LH values on trigger day (mIU/ml) | 1.51 (0.82–2.64) | 2.28 (1.29–4.29)a | 1.56 (1.15–2.32)b | < 0.001; a < 0.001; b 0.001 |
FSH values on trigger day (mIU/ml) | 20.22 (16.87–22.94) | 20.05 (16.43–26.38) | 18.91 (16.54–23.08) | 0.766 |
P values on trigger day (ng/ml) | 0.65 (0.49–0.92) | 0.73 (0.56–1.09) | 0.77 (0.56–1.12) | 0.047; a 0.025 |
Gn dose (IU) | 2285 (2025–3025) | 2600 (2100–3160) | 2400 (2212.5-2937.5) | 0.182 |
Gn duration (day) | 10 (8–11) | 10 (9–11) | 10 (9–11) | 0.449 |
Growth hormone utilization rate n (%) | 37 (25.5%) | 37 (31.1%) | 25 (55.6%)ab | 0.001; a < 0.001; b 0.004 |
AMH < 0.5ng/ml n (%) | 48 (33.1%) | 28 (23.5%) | 1 (2.2%)ab | < 0.001; a < 0.001; b 0.001 |
Oocytes retrieved < 4 n (%) | 59 (40.7%) | 49 (41.2%) | 11 (24.4%) | 0.11; a 0.048; b 0.047 |
Oocytes retrieved (n) | 4 (2–6) | 4 (2–6) | 8 (3.5–10)ab | < 0.001; a < 0.001; b < 0.001 |
Rate of 2PN fertilized oocytes | 0.59 (0.33–0.83) | 0.67 (0.41–0.83) | 0.67(0.43–0.78) | 0.528 |
Rate of transplantable embryos | 0.5 (0.23–0.75) | 0.5 (0.28–0.67) | 0.38 (0.28–0.64) | 0.568 |
Good-quality embryo rate | 0.33 (0-0.5) | 0.28 (0-0.5) | 0.33 (0.20–0.45) | 0.947 |
Cycle cancellation rate n (%) | 29 (20.0%) | 17 (14.3%) | 4 (8.9%) | 0.162 |
Chemical pregnancy rate per cycle (%) | 61.3% (49/80) | 56.7% (51/90) | 80.5% (33/41)b | 0.03; b 0.008 |
Clinical pregnancy rate per cycle (%) | 51.2%(41/80) | 44.9%(40/89) | 61%(25/41) | 0.233 |
Live birth rate per cycle (%) | 23.3% (14/60) | 23.2% (16/69) | 33.3% (9/27) | 0.546 |
Miscarriage rate (%) | 17.5% (7/40) | 10% (4/40) | 4.2% (1/24) | 0.227 |
Data are presented as median (25%IQR-75%IQR) or n (%). IQR, interquartile range; PPOS: progestin-primed ovarian stimulation; GnRH-Ant: GnRH antagonist; GnRH-a: GnRH-agonist; BMI: body mass index; AMH, anti-Mullerian hormone; AFC, antral follicle count; E2: estradiol; FSH: follicle stimulation hormone; LH: luteinizing hormone; P: progesterone; Gn: gonadotropin; 2PN: two pronuclear. “a” represents significant difference when compared with PPOS group; “b” represents significant difference when compared with GnRH-Ant group. (P < 0.05, Padjust < 0.017 for multiple comparisons in chi-square test and Kruskal Wallis Test) |
Due to the low number of live births, we chose the clinical pregnancy rate for the cut-off analysis. ROC analysis was performed to detect the predictive efficiency of AFC, AMH and number of oocytes retrieved for clinical pregnancy rate. AFC and number of oocytes retrieved were more efficiency than AMH. The cutoff values for AFC, AMH and number of oocytes retrieved were respectively 6.5 follicles, 0.575 ng/ml and 3.5 follicles (Fig. 1). The cutoff values were used for the following stratified analysis.
AFC was used for stratified analysis in Table 2. When AFC < 7 follicles, AFC, basal estradiol, estradiol on trigger day, growth hormone utilization rate and LBR was significantly increased in GnRH-a group than the other two (P = 0.049, P = 0.03, P = 0.007, P < 0.001, P = 0.046). Dose of Gn was highest in the GnRH-Ant group (P = 0.048). However, there were no significantly difference in embryo status and pregnancy outcomes between GnRH-Ant group and PPOS group. When AFC ≥ 7 follicles, AFC, estradiol on trigger day, the growth hormone usage and number of oocytes retrieved in GnRH-a group was significantly higher than that in the other two groups (P = 0.002, P = 0.007, P = 0.01, P = 0.015). However, there were no significant changes in embryo status and pregnancy outcome among the three groups.
Table 2
Basic characteristics, ovarian stimulation and embryo characteristics, pregnancy outcomes in three regimens stratified by AFC
Parameter | AFC < 7 | P | AFC > = 7 | P |
| PPOS (N = 61) | GnRH-Ant (N = 47) | GnRH-a (N = 6) | | PPOS (N = 84) | GnRH-Ant (N = 72) | GnRH-a (N = 39) | |
Age (year) | 32 (29–33) | 31 (28–33) | 30 (29-31.25) | 0.296 | 31.5 (30–33) | 31 (29–33) | 31 (30–33) | 0.596 |
Primary infertility n (%) | 35 (57.4%) | 22 (46.8%) | 5 (83.3%) | 0.169 | 38 (45.2%) | 37 (51.4%) | 22 (56.4%) | 0.484 |
Duration of infertility (year) | 4 (2–5) | 3 (2–4) | 3 (1.75–4.25) | 0.433 | 3 (2–5) | 3 (2–5) | 3 (1–5) | 0.708 |
BMI (kg/m2) | 22 (19.8-23.95) | 21.8 (19.5–24.7) | 21.15 (19.15–23.02) | 0.804 | 21.8 (20-23.98) | 20.5 (19.2–22.3) | 21.3 (18.9–22.9) | 0.04 |
AMH (ng/ml) | 0.47 (0.26–0.69) | 0.6 (0.39–0.83) | 0.7 (0.55–0.86) | 0.1 | 0.89 (0.62–1.06) | 0.83 (0.60–1.01) | 0.87 (0.71–1.05) | 0.441 |
AFC | 5 (4–6) | 5 (3–5) | 6 (5–6)b | 0.049 b 0.014 | 8 (7–11) | 9 (8–12) | 11 (9–12)a | 0.002 a 0.001 |
Basal E2 (pg/ml) | 40.54 (32.02–59.02) | 35.94 (26.71–52.67) | 65.56 (43.71–87.78) | 0.03 | 41.86 (32.51–53.68) | 48.08 (37.32–62.56) | 41.80 (34.91–52.10) | 0.047 |
Basal LH (mIU/ml) | 3.42 (2.57–5.66) | 3.2 (2.16–4.67) | 2.56 (1.93–3.42) | 0.265 | 2.94 (2.45–3.81) | 3.39 (2.26–4.34) | 3.60 (2.37–4.84) | 0.337 |
Basal FSH (mIU/ml) | 11.8 (7.78–16.82) | 10.61 (8.38–14.58) | 8.24 (6.02–14.22) | 0.405 | 9.32 (7.69–11.03) | 8.99 (7.34–10.97) | 8.09 (7.18–9.56) | 0.059 |
Basal P (ng/ml) | 0.65 (0.44–1.04) | 0.66 (0.44–0.80) | 0.41 (0.23–0.6) | 0.151 | 0.54 (0.44–0.84) | 0.64 (0.50–1.01) | 0.59 (0.35–0.70) | 0.117 |
E2 values on trigger day (pg/ml) | 932.61 (528.19-1358.64) | 1062.38 (782.03-1497.39) | 2242.72 (1159.38-3675.11)ab | 0.007 a 0.003 b 0.015 | 1500.62 (1168.25-2245.34) | 1641.49 (1120.71-2532.20) | 2516.55 (1331.52-3219.14)ab | 0.007 a 0.002 b 0.016 |
LH values on trigger day (mIU/ml) | 2.03 (1.14–2.98) | 2.92 (1.35–5.08) | 1.75 (1.36–2.16) | 0.086 | 1.26 (0.62–2.34) | 2.17 (1.23–4.11) a | 1.56 (1.10–2.37)b | < 0.001 a < 0.001 b 0.008 |
FSH values on trigger day (mIU/ml) | 21.4 (16.95–24.08) | 21.31 (17.09–30.06) | 19.06 (15.84–25.70) | 0.388 | 19.81 (16.34–22.28) | 19.29 (15.76–24.31) | 18.91 (16.64–23.53) | 0.99 |
P values on trigger day (ng/ml) | 0.68 (0.44–0.92) | 0.67 (0.49–0.93) | 0.84 (0.48–1.29) | 0.644 | 0.64 (0.51–0.93) | 0.84 (0.60–1.16)a | 0.76 (0.57–1.12) | 0.017 a 0.004 |
Gn dose (IU) | 2400 (2025–3100) | 3000 (2400–3660)a | 2325 (1971.25-3391.25) | 0.048 a 0.016 | 2265 (2025–3000) | 2347.5 (2025–2880) | 2400 (2250–2875) | 0.736 |
Gn duration (day) | 9 (8-11.5) | 10 (9–12) | 8.5 (7-11.5) | 0.143 | 10 (9–11) | 10 (9–10) | 10 (9–11) | 0.891 |
Growth hormone utilization rate n (%) | 15 (24.6%) | 21 (44.7%) | 6 (100%)a | < 0.001 a 0.001 | 22 (26.2%) | 16 (22.2%) | 19 (48.7%)ab | 0.01 a 0.014 b 0.004 |
Oocytes retrieved (n) | 2 (1–4) | 3 (2–4) | 7 (1–9) | 0.125 | 5 (4–7) | 5 (3-7.75) | 8 (4–10)ab | 0.015 a 0.006 b 0.012 |
Rate of 2PN fertilized oocytes | 0.54 (0.24-1) | 0.67 (0.42-1) | 0.54 (0.21–0.88) | 0.48 | 0.6 (0.41–0.79) | 0.64 (0.40–0.76) | 0.67(0.50–0.75) | 0.604 |
Rate of transplantable embryos | 0.5 (0–1) | 0.5 (0.28–0.76) | 0.53 (0-0.72) | 0.784 | 0.5 (0.25–0.67) | 0.5 (0.28–0.67) | 0.38 (0.28–0.60) | 0.756 |
Good-quality embryo rate | 0.33 (0-0.85) | 0.42 (0-0.67) | 0.33 (0-0.64) | 0.971 | 0.27 (0-0.5) | 0.26 (0-0.5) | 0.33 (0.20–0.40) | 0.765 |
Cycle cancellation rate n (%) | 18 (29.5%) | 8 (17%) | 2 (33.3%) | 0.277 | 11 (13.1%) | 9 (12.5%) | 2 (5.1%) | 0.337 |
Chemical pregnancy rate per cycle (%) | 37% (10/27) | 51.5% (17/33) | 75% (3/4) | 0.264 | 73.6% (39/53) | 59.6% (34/57) | 81.1% (30/37) | 0.067 |
Clinical pregnancy rate per cycle (%) | 33.3% (9/27) | 31.3% (10/32) | 75% (3/4) | 0.235 | 60.4% (32/53) | 52.6% (30/57) | 59.5% (22/37) | 0.677 |
Live birth rate per cycle (%) | 21.7% (5/23) | 14.3% (4/28) | 75% (3/4) | 0.046 | 24.3% (9/37) | 29.3% (12/41) | 26.1% (6/23) | 0.883 |
Miscarriage rate (%) | 0 | 20% (2/10) | 0 | | 21.9% (7/32) | 6.7% (2/30) | 4.5% (1/22) | 0.084 |
Ectopic pregnancy rate (%) | 0 | 0 | 0 | | 0 | 0 | 4.5% (1/22) | |
Data are presented as median (25%IQR-75%IQR) or n (%). IQR, interquartile range; PPOS: progestin-primed ovarian stimulation; GnRH-Ant: GnRH antagonist; GnRH-a: GnRH-agonist; BMI: body mass index; AMH, anti-Mullerian hormone; AFC, antral follicle count; E2: estradiol; FSH: follicle stimulation hormone; LH: luteinizing hormone; P: progesterone; Gn: gonadotropin; 2PN: two pronuclear. “a” represents significant difference when compared with PPOS group; “b” represents significant difference when compared with GnRH-Ant group. (P < 0.05, Padjust <0.017 for multiple comparisons in chi-square test and Kruskal Wallis Test) |
AMH was used for stratified analysis in Table 3. When AMH < 0.575ng/ml, GnRH-a group had significantly lower basal FSH level (P = 0.024) and higher AMH (P = 0.033) than the other two groups. LH values on trigger day was increased significantly in the GnRH-Ant group (P = 0.007). Growth hormone utilization rate was highest in GnRH-a group (P = 0.001). When AMH ≥ 0.575 ng/ml, AFC value, estradiol on trigger day, growth hormone usage and number of oocytes retrieved were significantly higher in GnRH-a group than the other two groups (P = 0.006, P < 0.001, P = 0.047, P = 0.002). However, there were no significant changes in embryo status and pregnancy outcome among the three groups.
Table 3
Basic characteristics, ovarian stimulation and embryo characteristics, pregnancy outcomes in three regimens stratified by AMH
Parameter | AMH < 0.575ng/ml | P | AMH > = 0.575ng/ml | P |
| PPOS (N = 59) | GnRH-Ant (N = 38) | GnRH-a (N = 5) | | PPOS (N = 86) | GnRH-Ant (N = 81) | GnRH-a (N = 40) | |
Age (year) | 32 (30–33) | 31 (28.75-33) | 32 (28.5–33.5) | 0.463 | 32 (29–33) | 31 (29–33) | 31 (30–33) | 0.652 |
Primary infertility n (%) | 33 (55.9%) | 17 (44.7%) | 2 (40%) | 0.493 | 40 (46.5%) | 42 (51.9%) | 25 (62.5%) | 0.247 |
Duration of infertility (year) | 4 (2–5) | 3 (2–4) | 2 (1–5) | 0.366 | 3 (2–5) | 3 (2–5) | 3 (1–4) | 0.833 |
BMI (kg/m2) | 21.5 (19.6–23.5) | 21.7 (19.5-24.18) | 20.3 (19.4–22.7) | 0.822 | 22 (20.28–24.1) | 20.7 (19.1–23) | 21.35 (19.05–22.88) | 0.038 |
AMH (ng/ml) | 0.37 (0.24–0.47) | 0.40 (0.22–0.51) | 0.53 (0.46–0.56)a | 0.033 a 0.005 | 0.95 (0.77–1.08) | 0.89 (0.75–1.02) | 0.88 (0.76–1.04) | 0.281 |
AFC | 5 (4–7) | 6 (3.75-8) | 11 (5.5–13.5) | 0.09 | 8 (6.75–10.25) | 8 (6–11) | 11 (8–12)a | 0.006 a 0.002 |
Basal E2 (pg/ml) | 41.60 (32.08–62.80) | 45.32 (29.60-53.83) | 63.94 (33.84–82.64) | 0.508 | 40.26 (32.39–54.03) | 45.77 (33.33–58.79) | 41.92 (35.86–51.84) | 0.481 |
Basal LH (mIU/ml) | 3.38 (2.55–5.18) | 2.98 (2.11–4.46) | 2.61 (1.59–3.21) | 0.139 | 3.04 (2.31–3.85) | 3.40 (2.29–4.49) | 3.62 (2.35–4.82) | 0.335 |
Basal FSH (mIU/ml) | 12.45 (8.44–16.56) | 10.61 (7.88–14.60) | 7.18 (6.27–8.32)a | 0.024 a 0.006 | 9.32 (7.48–10.92) | 9.23 (7.34–11.31) | 8.26 (7.22–9.65) | 0.263 |
Basal P (ng/ml) | 0.66 (0.44–0.97) | 0.72 (0.54–1.02) | 0.25 (0.23–0.56)ab | 0.017 a 0.015 b 0.002 | 0.56 (0.43–0.82) | 0.62 (0.48–0.81) | 0.58 (0.39–0.70) | 0.526 |
E2 values on trigger day (pg/ml) | 963.7 (484.16-1474.22) | 969.90 (744.36-1461.57) | 1054.12 (854.08-3378.52) | 0.501 | 1454.20 (1159.63-2236.27) | 1621.70 (1091.52-2488.78) | 2580.64 (1754.20-3223.83)a | < 0.001 a < 0.001 |
LH values on trigger day (mIU/ml) | 1.72 (1.05–3.11) | 3.14 (1.79–4.98)a | 1.63 (1.29–2.04) | 0.007 a 0.004 | 1.38 (0.64–2.35) | 2.07 (1.06–4.12)a | 1.56 (0.91–2.37) | 0.001 a < 0.001 |
FSH values on trigger day (mIU/ml) | 21.48 (18.72–24.46) | 20.88 (18.32–24.70) | 21.24 (19.66–31.87) | 0.855 | 19.51 (15.45–22.09) | 19.22 (15.64–27.13) | 18.47 (16.15–22.97) | 0.507 |
P values on trigger day (ng/ml) | 0.68 (0.44–0.92) | 0.72 (0.49–1.06) | 0.69 (0.50–1.23) | 0.544 | 0.65 (0.51–0.94) | 0.76 (0.57–1.09)a | 0.81 (0.58–1.12) | 0.093 |
Gn dose (IU) | 2400 (2025–3185) | 2645 (2000-3133.75) | 2440 (2200-3647.5) | 0.867 | 2250 (2025-3943.75) | 2600 (2175–3250) | 2400 (2193.75-2968.75) | 0.093 |
Gn duration (day) | 10 (8–11) | 9.5 (8–12) | 9 (8–11) | 0.873 | 9 (8–11) | 10 (9–11) | 10 (9–11) | 0.275 |
Growth hormone utilization rate n (%) | 13 (22%) | 11 (28.9%) | 5 (100%)ab | 0.001 a 0.001 b 0.005 | 24 (27.9%) | 26 (32.1%) | 20 (50%)a | 0.047 a 0.015 |
Oocytes retrieved (n) | 3 (1–4) | 3 (2–4) | 4 (2–9) | 0.398 | 5 (3.75-7) | 4 (3–7) | 8 (5-10.75)a | 0.002 a 0.001 |
Rate of 2PN fertilized oocytes | 0.6 (0.27–0.85) | 0.67 (0.5-1) | 0.75 (0.54-1) | 0.176 | 0.58 (0.42–0.80) | 0.6 (0.38–0.79) | 0.64 (0.43–0.75) | 0.935 |
Rate of transplantable embryos | 0.37 (0-0.75) | 0.5 (0.06–0.67) | 0.62 (0.1–0.71) | 0.998 | 0.5 (0.25–0.75) | 0.5 (0.33–0.69) | 0.38 (0.28–0.59) | 0.292 |
Good-quality embryo rate | 0.25 (0-0.59) | 0.27 (0-0.62) | 0.5 (0.19–0.71) | 0.607 | 0.35 (0-0.5) | 0.31 (0-0.5) | 0.33 (0.20–0.40) | 0.933 |
Cycle cancellation rate n (%) | 18 (30.5%) | 11 (28.9%) | 1 (20%) | 0.875 | 11 (12.8%) | 6 (7.4%) | 3 (7.5%) | 0.444 |
Chemical pregnancy rate per cycle (%) | 52.2% (12/23) | 41.7% (10/24) | 75% (3/4) | 0.419 | 64.9% (37/57) | 62.1% (41/66) | 81.1% (30/37) | 0.125 |
Clinical pregnancy rate per cycle (%) | 43.5% (10/23) | 30.4% (7/23) | 50% (2/4) | 0.576 | 54.4% (31/57) | 50% (33/66) | 62.2% (23/37) | 0.493 |
Live birth rate per cycle (%) | 11.1% (2/18) | 4.8% (1/21) | 50% (2/4) | 0.092 | 28.6% (12/42) | 31.3% (15/48) | 30.4% (7/23) | 0.962 |
Miscarriage rate (%) | 30% (3/10) | 57.1% (4/7) | 0 | 0.199 | 12.9% (4/31) | 0 | 4.35% (1/23) | 0.042 |
Ectopic pregnancy rate (%) | 0 | 0 | 0 | | 0 | 0 | 4.35% (1/23) | |
Data are presented as median (25%IQR-75%IQR) or n (%). IQR, interquartile range; PPOS: progestin-primed ovarian stimulation; GnRH-Ant: GnRH antagonist; GnRH-a: GnRH-agonist; BMI: body mass index; AMH, anti-Mullerian hormone; AFC, antral follicle count; E2: estradiol; FSH: follicle stimulation hormone; LH: luteinizing hormone; P: progesterone; Gn: gonadotropin; 2PN: two pronuclear. “a” represents significant difference when compared with PPOS group; “b” represents significant difference when compared with GnRH-Ant group. (P < 0.05, Padjust < 0.017 for multiple comparisons in chi-square test and Kruskal Wallis Test) |
Number of oocytes retrieved was used for stratified analysis in Table 4. When number of oocytes retrieved < 4 follicles, the ovarian reserve function was better in GnRH-a group than the other two groups. AMH and AFC values were significantly higher (P = 0.015, P = 0.002) and basal FSH level was significantly lower (P = 0.012) in GnRH-a group than the other two groups, but the outcomes of embryo and pregnancy were not significantly improved. When the number of oocytes retrieved ≥ 4 follicles, AMH value was comparable in the three groups. AFC, number of oocytes retrieved and growth hormone usage were significantly higher in GnRH-a group than the other two groups (P = 0.003, P < 0.001, P = 0.005). However, embryo status and pregnancy outcomes were similar among the three groups. No matter how many oocytes were harvested, LH level on trigger day was significantly higher in GnRH-Ant group than the other two groups (P = 0.009, P < 0.001).
Table 4
Basic characteristics, ovarian stimulation and embryo characteristics, pregnancy outcomes in three regimens stratified by oocytes retrieved
Parameter | Oocytes retrieved < 4 | P | Oocytes retrieved > = 4 | P |
| PPOS (N = 59) | GnRH-Ant (N = 49) | GnRH-a (N = 11) | | PPOS (N = 86) | GnRH-Ant (N = 70) | GnRH-a (N = 34) | |
Age (year) | 31 (30–33) | 31 (29–33) | 32 (31–33) | 0.666 | 32 (29–33) | 31 (29–33) | 30.5 (29–33) | 0.266 |
Primary infertility n (%) | 35 (59.3%) | 19 (38.8%) | 8 (72.7%) | 0.037 | 38 (44.2%) | 40 (57.1%) | 19 (55.9%) | 0.225 |
Duration of infertility (year) | 3 (1–5) | 3 (2–4) | 5 (2–6)b | 0.078 b 0.013 | 3 (2–5) | 3 (2–5) | 2 (1–4) | 0.086 |
BMI (kg/m2) | 22.5 (20-24.8) | 20.8 (19.5–23.8) | 20.7 (19.8–23.1) | 0.146 | 21.3 (19.82–23.7) | 20.75 (19.18–23.1) | 21.35 (18.88–22.82) | 0.412 |
AMH (ng/ml) | 0.5 (0.26–0.86) | 0.57 (0.40–0.81) | 0.78 (0.71–1.08)ab | 0.015 a 0.006 b 0.014 | 0.86 (0.58–1.07) | 0.83 (0.62–1.02) | 0.86 (0.70–1.01) | 0.883 |
AFC | 5 (4–7) | 6 (4–8) | 9 (7–11)ab | 0.002 a < 0.001 b 0.003 | 8 (6.75–10.25) | 9 (6–12) | 11 (8-12.25)a | 0.003 a 0.001 |
Basal E2 (pg/ml) | 43.70 (34.57–59.79) | 46.26 (31.40–56.9) | 36.77 (32.14–60.61) | 0.776 | 39.06 (30.75–50.01) | 45.25 (32.86–57.77) | 45.31 (37.21–54.62) | 0.097 |
Basal LH (mIU/ml) | 3.38 (2.30–5.32) | 3.2 (2.13–4.56) | 3.06 (2.27–4.02) | 0.542 | 3.12 (2.48–3.88) | 3.41 (2.34–4.48) | 3.56 (2.34–4.84) | 0.671 |
Basal FSH (mIU/ml) | 10.77 (8.39–16.48) | 9.42 (7.37–14.89) | 8.09 (6.98–8.74)a | 0.012 a 0.003 | 9.34 (7.42–11.42) | 9.25 (7.40-11.08) | 8.14 (7.10-10.26) | 0.286 |
Basal P (ng/ml) | 0.56 (0.44–0.86) | 0.66 (0.5–1.04) | 0.52 (0.35–0.74) | 0.284 | 0.64 (0.4–0.87) | 0.66 (0.50–0.87) | 0.58 0.32–0.70) | 0.192 |
E2 values on trigger day (pg/ml) | 742.44 (484.16-1347.33) | 1047.45 (643.74-1357.16) | 1054.12 (594.21-1923.65) | 0.25 | 1550.90 (1200.56-2236.27) | 1742.11 (1312-2524.10) | 2932.66 (1991.14-3440.06)a | < 0.001 a < 0.001 |
LH values on trigger day (mIU/ml) | 2.14 (1.2–3.24) | 3.22 (1.42–5.40) | 1.53 (0.47–2.16)b | 0.009 b 0.009 | 1.23 (0.64–2.17) | 2.10 (1.16–3.96)a | 1.58 (1.12–2.36) | < 0.001 a < 0.001 |
FSH values on trigger day (mIU/ml) | 21.45 (18.90-24.34) | 22.95 (18.03–28.39) | 18.40 (13.62–29.78) | 0.434 | 19.53 (15.9-22.01) | 19.08 (16.06–22.78) | 18.91 (16.64–22.62) | 0.815 |
P values on trigger day (ng/ml) | 0.61 (0.44–0.81) | 0.66 (0.48–1.06) | 0.45 (0.35–0.76) | 0.223 | 0.69 (0.51-1.00) | 0.82 (0.61–1.09) | 0.87 (0.66–1.13)a | 0.067 |
Gn dose (IU) | 2285 (1800–3150) | 2700 (2025–3365) | 2475 (2300–3075) | 0.326 | 2290 (2025–3000) | 2490 (2126.25–3050) | 2337.5 (2162.5-2871.25) | 0.561 |
Gn duration (day) | 9 (7–11) | 10 (9–12) | 10 (9–11) | 0.371 | 10 (9–11) | 10 (9–11) | 9.5 (9–11) | 0.692 |
Growth hormone utilization rate n (%) | 17 (28.8%) | 18 (36.7%) | 7 (63.6%) | 0.09 | 20 (23.3%) | 19 (27.1%) | 18 (52.9%)ab | 0.005 a 0.002 b 0.01 |
Oocytes retrieved (n) | 2 (1–3) | 2 (1–3) | 3 (1–3) | 0.19 | 5.5 (4–7) | 5.5 (4-8.25) | 8 (7-11.25)a | < 0.001 a < 0.001 |
Rate of 2PN fertilized oocytes | 0.5 (0–1) | 0.67 (0.33-1) | 1 (0.3-1) | 0.265 | 0.6 (0.48–0.8) | 0.6 (0.43–0.75) | 0.63 (0.43–0.75) | 0.993 |
Rate of transplantable embryos | 0.58 (0–1) | 0.67 (0.33-1) | 0.67 (0–1) | 0.764 | 0.5 (0.25–0.6) | 0.44 (0.28–0.6) | 0.38 (0.28–0.56) | 0.692 |
Good-quality embryo rate | 0.33 (0–1) | 0.33 (0-0.67) | 0.33 (0-0.67) | 0.9 | 0.30 (0-0.5) | 0.28 (0.13–0.5) | 0.33 (0.25–0.4) | 0.777 |
Cycle cancellation rate n (%) | 23 (39%) | 13 (26.5%) | 3 (27.3%) | 0.357 | 6 (7%) | 4 (5.7%) | 1 (2.9%) | 0.663 |
Chemical pregnancy rate per cycle (%) | 54.5% (12/22) | 29% (9/31) | 62.5% (5/8) | 0.083 | 63.8% (37/58) | 71.2% (42/59) | 84.8% (28/33) | 0.102 |
Clinical pregnancy rate per cycle (%) | 50% (11/22) | 19.4% (6/31) | 37.5% (3/8) | 0.06 | 51.7% (30/58) | 58.6% (34/58) | 66.7% (22/33) | 0.376 |
Live birth rate per cycle (%) | 17.6% (3/17) | 6.9% (2/29) | 16.7% (1/6) | 0.5 | 25.6% (11/43) | 35% (14/40) | 38.1% (8/21) | 0.512 |
Miscarriage rate (%) | 27.3% (3/11) | 33.3% (2/6) | 0 | 0.375 | 13.3% (4/30) | 5.9% (2/34) | 4.5% (1/22) | 0.435 |
Ectopic pregnancy rate (%) | 0 | 0 | 0 | | 0 | 0 | 4.5% (1/22) | |
Data are presented as median (25%IQR-75%IQR) or n (%). IQR, interquartile range; PPOS: progestin-primed ovarian stimulation; GnRH-Ant: GnRH antagonist; GnRH-a: GnRH-agonist; BMI: body mass index; AMH, anti-Mullerian hormone; AFC, antral follicle count; E2: estradiol; FSH: follicle stimulation hormone; LH: luteinizing hormone; P: progesterone; Gn: gonadotropin; 2PN: two pronuclear. “a” represents significant difference when compared with PPOS group; “b” represents significant difference when compared with GnRH-Ant group. (P < 0.05, Padjust < 0.017 for multiple comparisons in chi-square test and Kruskal Wallis Test) |