[Application of GnRH-antagonist to IVF-ET for patients with poor ovarian response]

Abstract

Objective: To compare the outcomes achieved by GnRH-antagonist and GnRH-agonist in IVF-ET for patients with poor ovarian responses, and to find out a better protocol for ovulation stimulation.

Methods: (1) Patients with poor ovarian responses were assigned to an experimental (n = 63) and a control group (n = 58), treated respectively with GnRH-Ant and oral contraceptive plus micro-dose GnRH-a (OC + GnRH-a), and comparisons were made of the medication doses, laboratory results and pregnancy outcomes between the two groups. (2) Twenty of the patients were treated first with GnRH-Ant and then with OC + GnRH-a, and the same comparisons were made between the two protocols.

Results: Between the experimental and the control groups, there were no significant differences in the dose of Gn and number of retrieved oocytes and transplanted embryos (P > 0.05), nor in the pregnancy rate of transplantation cycles (37.29% vs 35.29%). The cycle cancellation rate was lower in the experimental than in the control group (6.35% vs 12.07%), with no statistical difference (P > 0.05). The cycle duration was significantly different between the two groups ([9.65 +/- 1.60] d vs [19.05 +/- 3.94] d) (P < 0.05). As for the comparison of GnRH-Ant with GnRH-a, no significant differences were observed in the dose of Gn and the numbers of retrieved oocytes and transplanted embryos (P > 0.05). GnRH-Ant achieved a higher pregnancy rate of transplantation cycles but a significantly lower cancellation rate than GnRH-a (38.09% vs 17.64% and 0% vs 15%) (P > 0.05 and P < 0.01), respectively. The cycle duration of the former was statistically shorter than that of the latter ([9.91 +/- 2.49] d vs [27.74 +/- 25.39] d) (P < 0.05).

Conclusion: Compared with micro-dose GnRH-a, GnRH-Ant can shorten the cycle duration and reduce the cancellation rate in IVF-ET for patients with poor response. And for those who have failed to respond to GnRH-a, GnRH-Ant may be tried in another attempt at IVF-ET.