Evaluation of GnRH antagonist pretreatment before ovarian stimulation in a GnRH antagonist protocol in women with poor ovarian response undergoing IVF/ICSI: A retrospective propensity-score-matching study

Abstract

Backgroud: A low number of retrieved oocytes significantly affects the clinical pregnancy rate (CLR) in patients with a poor ovarian response (POR).The aim of this study was to assess the effect of GnRH antagonist（GnRH-ant） pretreatment performed on days 2 to 4 of the menstrual cycle on pregnancy outcomes in women with POR undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI). Methods: We conducted a retrospective study of 208 women with POR undergoing IVF/ICSI from January 2018 to August 2021. The pretreatment GnRH-ant protocol (study group) comprised 32 patients, and the conventional antagonist protocol (control group) included 176 patients. A propensity-score-matching (PSM) method using nearest neighbour matching at a proportion of 1:3 was performed. After PSM, we compared the pregnancy outcomes of each group. Results: After PSM, there was no significant difference in age, antral follicle count (AFC), AMH level, or gonadotropin (Gn) level between the two groups (P>0.5). There were no significant differences in the number of retrieved oocytes, mature oocytes, normally fertilized oocytes, transferable embryos, and good-quality embryos between the two groups (P>0.05). There were no significant differences in biochemical and clinical pregnancy rates between the two groups (P>0.05). The implantation rate [34.4% (11/32)] and live birth rate [50.0% (8/16)] of the studygroup were higher than those of the control group [15.5% (9/58), P=0.039; 13.8% (4/29), P=0.014]. Conclusions: Treatment with a GnRH antagonist on day 2 to day 4 of the menstrual cycle did not increase the number of retrieved oocytes or the clinical pregnancy rate in women with POR undergoing IVF/ICSI, but it may increase the live birth rate. Trial registration: Chinese Clinical Trial Registry, ChiCTR1800019730.