Comparison of the cumulative live birth rates after one ART cycle
including all subsequent frozen--thaw cycles in women undergoing IVF
using progestin primed ovarian stimulation versus long GnRH agonist
protocol
Abstract
Background There is scarcity of information about the cumulative live
birth rates(CLBRs) and time to live birth(TTLB) between progestin primed
ovarian stimulation protocol(PPOS) and long GnRH agonist protocol.
Objective To compare CLBRs and TTLB in women with normal ovarian reserve
following PPOS with long GnRH agonist protocol. Methods A total of 995
women who underwent IVF using either PPOS (n=509) or GnRH antagonist
(n=486) ovarian stimulation at the discretion of the attending
physicians. The primary outcome measure was the CLBRs within 18 months
from the day of ovarian stimulation. Results Both groups had almost
comparable demographic and cycle stimulation characteristics except for
duration of infertility which was shorter in the PPOS group. CLBRs after
one complete IVF cycle including fresh and subsequent FET cycles within
18 months follow up were significantly lower in the PPOS group compared
that in the long agonist group 206/509 (40.5%) and 307/486 (63.2%),
respectively (odds ratio (OR): 0.641; 95% CI: 0.565-0.726). The average
TTLB was significantly shorter in the long agonist group compared to the
PPOS group (P < 0.01). In Kaplan-Meier analysis, the
cumulative incidence of ongoing pregnancy leading to LB was
significantly higher in the long agonist compared in the PPOS group (P
< 0.001). Cox regression analysis revealed stimulation
protocol adopted was strongly associated with the CLBRs after adjusting
other confounding factors (OR =1.917 (1.152-3.190), P=0.012). Conclusion
PPOS offers no advantage over conventional protocol in women with a
normal ovarian reserve undergoing IVF. Keywords: PPOS, long GnRH agonist
protocol, IVF, CLBRs, TTLB