高龄预期低反应患者体外受精助孕微刺激方案和拮抗剂方案效果分析OA

Objectives:To compare the effects of micro-stimulation protocol and GnRH-antagonist protocol of in vitro fertilization among pregnant women with advanced age and poor ovarian response. Methods:Patients with advanced age and poor ovarian response who underwent in vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI)at Mianyang Central Hospital from January 2020 through December 2024 were enrolled in this study.According to the ovulation induction protocol and different age groups,the patients were divided into 4 subgroups:A1(using the antagonist protocol,aged 35-39 years),A2(using the antagonist protocol,aged≥40 years),B1(using the micro-stimulation protocol,aged 35-39 years),B2(using the micro-stimulation protocol,aged 40 years).The number of oocytes retrieved,laboratory indicators,and the cost of fertility treatment in each subgroup(including the cost of ovulation induction drugs required to obtain one oocyte,the total cost of obtaining one available embryo,and the total cost of obtaining one D3 high-quality embryo)were retrospectively analyzed. Results:There were no significant differences in general data such as age,duration of infertility,body mass index,etc.among the subgroups in the subgroups with the same age(A1 and B1,A2 and B2).Regarding the age of 35-39 cohort,the antagonist regimen(group A1)significantly increased the number of retrieved oocytes,the number of 2PN,the number of available embryos,the number of D3 high-quality embryos,and D3 high-quality embryo rate when compared with the micro stimulation regimen(group B1)(P＜0.05).However,the dosage of gonadotropin(Gn)use,cost of ovulation induction,cost of obtaining one oocyte,cost of obtaining one available embryo,and cost of obtaining one D3 high-quality embryo all significantly increased(P＜0.05).As for the patients aged 40 years and above,the antagonist regimen(group A2)also significantly increased the number of retrieved oocytes,the number of 2PN,the number of available embryos,the number of D3 high-quality embryos,and D3 high-quality embryo rate when compared with the micro stimulation regimen(group B2)(P＜0.05),and the difference between the two subgroups was smaller than that in the group of 35-39 years old.The dosage of gonadotropin(Gn)use,cost of ovulation induction,cost of obtaining one oocyte,cost of obtaining one available embryo,and cost of obtaining one D3 high-quality embryo all significantly increased,too(P＜0.05). Conclusions:The advantages of the GnRH-antagonist protocol for ovulation induction weaken with the increase of age among pregnant women with advanced age and poor ovarian response.For patients aged 40 years and above,the micro-stimulation protocol is more in line with the principle of cost-effectiveness.The clinical decisions need to be comprehensively weighed in combination with the patient's age,economic conditions and treatment goals.