Journal
FRONTIERS IN ENDOCRINOLOGY
Volume 12, Issue -, Pages -Publisher
FRONTIERS MEDIA SA
DOI: 10.3389/fendo.2021.618580
Keywords
GnRH agonist; GnRH antagonist; ovarian stimulation; LH levels; reproductive outcomes
Categories
Funding
- 1351 Talent training Program of Beijing Chao-Yang Hospital [CYXX-2017-20, CYMY-2017-21]
- Capital Health Development Scientific Research Project (Independent Innovation) [2020-1-2039]
- Beijing Health Promotion Foundation [2019-09-05]
- 2018 Fertility Research Program of Young and Middle-aged Physicians-China Health Promotion Foundation [QML20200301]
- 2020 Fertility Research Program of Young and Middle-aged Physicians-China Health Promotion Foundation
- Beijing Hospitals Authority Youth Programme
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A retrospective cohort study on 110 patients with deep ovarian suppression found that a modified GnRH antagonist protocol based on LH levels during the second ovarian stimulation cycle resulted in significantly better reproductive outcomes compared to continuing with GnRH agonist long protocol. The use of modified protocol led to higher ongoing pregnancy and live birth rates, and lower cancellation rate, suggesting that patients may benefit from adjusting their treatment based on LH levels.
Objective To verify if patients with deep ovarian suppression following gonadotropin releasing hormone (GnRH) agonist long protocol may benefit from a modified GnRH antagonist protocol based on luteinizing hormone (LH) levels. Design Retrospective cohort study. Setting University-based hospital. Patients 110 patients exhibited ultra-low LH levels during ovarian stimulation using GnRH agonist long protocol. Intervention(s) As all the embryos in the first cycle were exhausted without being pregnant, these patients proposed to undergo a second cycle of ovarian stimulation. 74 of them were treated with a modified GnRH antagonist protocol based on LH levels. Other 36 patients were still stimulated following GnRH agonist long protocol. Main Outcome Measure The primary outcome was live birth rate (LBR). The second outcomes were biochemical pregnancy rate, clinical pregnancy rate (CPR), ongoing pregnancy rate (OPR) and cancellation rate. Results Reproductive outcomes were much better in the modified GnRH antagonist protocol. The OPR and LBR were much higher in the GnRH antagonist protocol group than in the GnRH agonist long protocol group [odds ratio (OR) 3.82, 95% confidence interval (CI) 1.47, 10.61, P=0.018; OR 4.33, 95% CI 1.38, 13.60, P=0.008; respectively]. Meanwhile, the cancellation rate was much lower in the GnRH antagonist protocol group (OR 0.13, 95% CI 0.02, 0.72; P=0.014). Mean LH level during stimulation did not have a predictive value on live birth. However, it was independently associated with the occurrence of ongoing pregnancy (OR 2.70, 95% CI 1.25, 5.85; P=0.01). The results of sensitivity analyses were consistent with the data mentioned above. The patients got completely different and excellent clinical outcomes in their second cycles stimulated with the modified GnRH antagonist protocol. Conclusion Patients with deep ovarian suppression following GnRH agonist long protocol may benefit from a modified GnRH antagonist protocol based on LH levels.
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