Responses and Reproductive Outcomes Across Four Ovarian Stimulation Protocols in Poor Responders: A Retrospective Cohort Study
DOI:
https://doi.org/10.52609/jmlph.v6i3.196Keywords:
Embryo Transfer, Fertilization in Vitro, Follicle Stimulating Hormone, Gonadotropin-Releasing Hormone, Gonadotropins, Intracytoplasmic, Menotropins, Ovarian Reserve, Ovulation Induction, Retrospective Studies, Sperm InjectionsAbstract
Background: The optimal approach to ovarian stimulation in poor responders remains controversial. This study aimed to compare four stimulation treatment protocols to improve reproductive outcomes in patients undergoing controlled ovarian hyperstimulation prior to in-vitro fertilization/intracytoplasmic sperm injection under gonadotropin-releasing hormone antagonist regimens.
Methods: A retrospective cohort study was conducted among poor responder female patients. The participants were divided into four groups according to treatment protocol—Group 1: High-dose rFSH (≥300 IU) with rLH; Group 2: hMG with rFSH (≥300 IU); Group 3: rFSH (≥300 IU/day) alone; Group 4: hMG (≥300 IU) alone —and followed up to determine their reproductive outcomes.
Results: A total of 157 poor responders were included. Baseline characteristics were comparable across the four treatment groups, with no significant differences in age, BMI, duration of infertility, or basal E2, PRL, and TSH levels. Basal FSH and LH levels showed statistically significant differences between groups (p=0.049 and p=0.007, respectively), although median FSH values were similar overall. Causes of infertility did not differ significantly among groups.
Treatment duration, final E2 levels, follicle numbers, oocyte yield, embryo numbers, and ICSI outcomes were comparable across groups. However, total gonadotropin dose differed significantly, with the rFSH + LH group requiring the highest dose. Pregnancy outcomes—including positive pregnancy test rates, clinical pregnancy, implantation, and live birth rates—were not significantly different among treatment groups. Miscarriage history differed significantly, with the highest proportion observed in the hMG group (p=0.046). Of 135 patients undergoing embryo transfer, 39.3% (n=53) had positive pregnancy tests, resulting in 28 live births. No ectopic pregnancies occurred. Live birth distribution did not differ significantly by age group or treatment regimen (p=0.553).
Conclusions: rFSH doses higher than 300 IU did not significantly alter reproductive outcomes, raising the question of whether such high doses of gonadotropins are advisable in this patient population.
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