Comparison of clinical outcomes between gonadotropin-releasing hormone agonist long protocol in early follicular phase and gonadotropin-releasing hormone antagonist protocol in patients with poor ovarian response at different ages

Objective To explore the suitable protocol for poor ovarian response (POR) patients in young and advanced ages. Methods The data of 654 in vitro fertilization (IVF) cycles in POR women between January 2015 and December 2017 in Henan Provincial People’s Hospital were collected retrospectively. The cycles were divided into four groups according to protocol and the age: group A [gonadotropin-releasing hormone antagonist (GnRH-A) protocol, <35 years old, 134 cycles], group B [gonadotropin-releasing hormone agonist (GnRH-a) long protocol in early follicular phase, <35 years old, 150 cycles], group C (GnRH-A protocol, ≥35 years old, 172 cycles) and group D (GnRH-a long protocol in early follicular phase, ≥35 years old, 198 cycles). The general characteristics, clinical and laboratory data and clinical outcomes were compared among the four groups. Results The general characteristics had no significant difference between group A and group B, group C and group D (P>0.05). Total dosage of gondotropin (Gn) used, duration of Gn used, endometrial thickness on human chorionic gonadotropin (hCG) injection day were significantly lower (P 0.05). Conclusion The clinical outcomes of the GnRH-a long protocol in early follicular phase and the GnRH-A protocol in POR patients are comparable, but the GnRH-A protocol is more cost-effective. Key words: Fertilization in vitro; Embryo transfer; Advanced maternal age; Poor ovarian response; Gonadotropin-releasing hormone antagonist protocol; Long protocol; Live birth rate