Background
Methods
Study design and patients
COS protocols
EFPL protocol
GnRH-Ant protocol
Statistics
Results
General outcomes
Before matching | After matching | |||||
---|---|---|---|---|---|---|
Parameter | EFPL | GnRH-Ant |
P
| EFPL | GnRH-Ant |
P
|
Number of ovum pick up cycles | 1537 | 1773 | 400 | 400 | ||
Age (year) | 31.00 (28.00–33.00) | 32.00 (29.00–35.00) | < 0.001 | 30.00 (28.00–33.00) | 30.00 (28.00–33.00) | 0.67 |
Primary infertility (%) | 59.60 (916/1537) | 53.13 (942/1773) | < 0.001 | 59.75 (239/400) | 59.50 (238/400) | 0.94 |
Duration of infertility (year) | 3.00 (2.00–5.00) | 3.00 (2.00–5.00) | 0.33 | 3.00 (2.00-4.19) | 3.00 (2.00–5.00) | 0.08 |
Cause of infertility (%) | < 0.001 | 0.25 | ||||
Pelvic and tubal factor | 30.32 (466/1537) | 22.39 (397/1773) | 29.00 (116/400) | 26.75 (107/400) | ||
DOR | 1.04 (16/1537) | 9.31 (165/1773) | 1.50 (6/400) | 2.75 (11/400) | ||
PCOS or ovulation dysfunction | 8.85 (136/1537) | 8.52 (151/1773) | 12.25 (49/400) | 11.50 (46/400) | ||
Endometriosis or adenomyosis | 5.53 (85/1537) | 1.69 (30/1773) | 4.75 (19/400) | 2.00 (8/400) | ||
Male factor | 12.23 (188/1537) | 9.42 (167/1773) | 12.00 (48/400) | 10.75 (43/400) | ||
Complex male and female factors | 18.35 (282/1537) | 18.89 (335/1773) | 19.75 (79/400) | 20.50 (82/400) | ||
Complex female factors | 15.29 (235/1537) | 23.63 (419/1773) | 15.25 (61/400) | 19.50 (78/400) | ||
Others | 8.39 (129/1537) | 6.15 (109/1773) | 5.50 (22/400) | 6.25 (25/400) | ||
BMI (kg/m2) | 21.70 (19.90–24.00) | 22.00 (20.20–24.50) | < 0.01 | 22.30 (20.20–24.4) | 22.00 (20.05–24.20) | 0.53 |
AMH (ng/ml) | 3.96 (2.70–5.64) | 2.46 (1.20–5.24) | < 0.001 | 3.94 (2.57–6.38) | 3.75 (2.29–6.20) | 0.17 |
Basal E2 (pg/ml) | 41.92 (32.14–56.26) | 42.66 (34.14–55.69) | 0.15 | 43.04 (33.25–55.40) | 41.94 (34.34–52.56) | 0.60 |
Basal LH (mIU/ml) | 3.97 (2.84–5.54) | 3.85 (2.71–5.31) | 0.38 | 4.07 (2.99–5.54) | 4.02 (2.88–5.50) | 0.74 |
Basal FSH (mIU/ml) | 7.16 (5.89–8.41) | 7.74 (6.42–9.48) | < 0.001 | 7.34 (6.15–8.52) | 7.45 (6.20–8.77) | 0.19 |
Basal P (ng/ml) | 0.55 (0.37–0.75) | 0.55 (0.38–0.76) | 0.53 | 0.53 (0.36–0.73) | 0.55 (0.39–0.73) | 0.40 |
E2 on trigger day (pg/ml) | 2732.41 (1890.96-3774.40) | 2750.94 (1641.90-4260.62) | 0.99 | 2716.15 (1884.29-3685.65) | 3188.85 (2172.30-4899.94) | < 0.001 |
LH on trigger day (mIU/ml) | 0.56 (0.31–0.96) | 1.73 (0.95–3.12) | < 0.001 | 0.49 (0.28–0.94) | 1.52 (0.82–2.73) | < 0.001 |
P on trigger day (ng/ml) | 0.90 (0.65–1.21) | 0.93 (0.65–1.29) | 0.05 | 0.88 (0.58–1.21) | 1.02 (0.70–1.42) | < 0.001 |
Gn dose (IU) | 2025.00 (1611.25-2536.25) | 2025.00 (1650.00-2512.50) | 0.05 | 2100.00 (1650.00-2625.00) | 1950.00 (1579.38-2346.88) | < 0.01 |
Gn duration (day) | 11.00 (10.00–13.00) | 10.00 (9.00–11.00) | < 0.001 | 11.00 (10.00–13.00) | 10.00 (9.00–11.00) | < 0.001 |
Endometrial thickness (mm) | 12.20 (10.70–14.00) | 11.00 (9.90-12.45) | < 0.001 | 12.00 (10.80–14.00) | 11.00 (10.00-12.15) | < 0.001 |
Oocytes retrieved (n) | 13.00 (9.00–18.00) | 10.00 (5.00–17.00) | < 0.001 | 12.00 (9.00–18.00) | 13.00 (8.00–20.00) | 0.50 |
Type of fertilization (%) | < 0.001 | 0.31 | ||||
IVF | 73.06 (1123/1537) | 70.11 (1243/1773) | 72.00 (288/400) | 69.50 (278/400) | ||
ICSI | 19.45 (299/1537) | 26.06 (462/1773) | 21.50 (86/400) | 25.50 (102/400) | ||
Rescue ICSI | 7.48 (115/1537) | 3.84 (68/1773) | 6.50 (26/400) | 5.00 (20/400) | ||
Number of 2PN fertilized embryos n | 7.00 (4.00–10.00) | 6.00 (3.00–10.00) | < 0.001 | 7.00 (4.00–10.00) | 7.00 (4.00–12.00) | 0.16 |
Number of transportable embryos n | 4.00 (2.00–7.00) | 3.00 (2.00–6.00) | < 0.001 | 4.00 (3.00–7.00) | 4.00 (2.00–7.00) | 0.86 |
Number of good quality embryos n | 3.00 (2.00–6.00) | 3.00 (1.00–6.00) | < 0.001 | 4.00 (2.00–7.00) | 4.00 (2.00–7.00) | 0.20 |
OHSS (%) | 17.50 (269/1537) | 14.33 (254/1773) | 0.01 | 22.00 (88/400) | 23.25 (93/400) | 0.67 |
Cycle cancellation rate (%) | 3.45 (53/1537) | 7.16 (127/1773) | < 0.001 | 2.25 (9/400) | 7.25 (29/400) | < 0.01 |
Fresh embryo transfer rate (%) | 62.91 (967/1537) | 40.04 (710/1773) | < 0.001 | 61.50 (246/400) | 32.00 (128/400) | < 0.001 |
Reasons for canceling the fresh embryo transfer (%) | < 0.001 | < 0.01 | ||||
Prevention of OHSS | 54.56 (311/570) | 39.51 (420/1063) | 62.34 (96/154) | 45.59 (124/272) | ||
Embryo factor | 9.47 (54/570) | 12.98 (138/1063) | 7.79 (12/154) | 12.13 (33/272) | ||
Endometrial factor | 13.51 (77/570) | 13.45 (143/1063) | 9.09 (14/154) | 11.03 (30/272) | ||
Elevated P value | 10.18 (58/570) | 18.72 (199/1063) | 10.39 (16/154) | 19.12 (52/272) | ||
Hydrosalpinx | 1.93 (11/570) | 1.03 (11/1063) | 1.30 (2/154) | 0 | ||
Patient factors or others | 10.35 (59/570) | 14.30 (152/1063) | 9.09 (14/154) | 12.13 (33/272) |
Before matching | After matching | |||||
---|---|---|---|---|---|---|
Parameter | EFPL | GnRH-Ant |
P
| EFPL | GnRH-Ant |
P
|
Number of fresh embryo transfer cycles | 967 | 710 | 166 | 166 | ||
Number of embryos transferred | < 0.001 | 0.43 | ||||
1 | 32.06 (310/967) | 17.46 (124/710) | 24.70 (41/166) | 21.08 (35/166) | ||
2 | 67.94 (657/967) | 82.54 (586/710) | 75.30 (125/166) | 78.92 (131/166) | ||
Type of embryo transferred | < 0.001 | 0.01 | ||||
Cleavage embryo | 56.15 (543/967) | 85.49 (607/710) | 63.86 (106/166) | 76.51 (127/166) | ||
Blastocyst | 43.85 (424/967) | 14.65 (104/710) | 36.14 (60/166) | 23.49 (39/166) | ||
Number of good embryos transferred | < 0.001 | 0.16 | ||||
0 | 14.99 (145/967) | 9.58 (68/710) | 12.65 (21/166) | 6.63 (11/166) | ||
1 | 34.23 (331/967) | 29.01 (206/710) | 28.92 (48/166) | 28.92 (48/166) | ||
2 | 50.78 (491/967) | 61.41 (436/710) | 58.43 (97/166) | 64.46 (107/166) | ||
Chemical pregnancy rate per cycle | 67.94 (657/967) | 49.86 (354/710) | < 0.001 | 65.06 (108/166) | 48.80 (81/166) | < 0.01 |
Clinical pregnancy rate per cycle | 58.12 (562/967) | 41.27 (293/710) | < 0.001 | 56.02 (93/166) | 38.55 (64/166) | < 0.01 |
Live birth rate per cycle | 41.54 (356/857) | 25.90 (166/641) | < 0.001 | 39.49 (62/157) | 29.03 (45/155) | 0.05 |
Twin pregnancy rate | 21.35 (76/356) | 22.29 (37/166) | 0.81 | 19.35 (12/62) | 11.11 (5/45) | 0.25 |
Miscarriage rate | 15.73 (87/553) | 17.54 (50/285) | 0.50 | 21.11 (19/90) | 11.11 (7/63) | 0.10 |
Pregnancy type | 0.42 | 0.89 | ||||
Intrauterine pregnancy | 98.04 (551/562) | 96.59 (283/293) | 96.77 (90/93) | 98.44 (63/64) | ||
Heterotopic pregnancy rate | 1.60 (9/562) | 2.73 (8/293) | 3.22 (3/93) | 1.56 (1/64) | ||
Simultaneous intrauterine and extrauterine pregnancy | 0.36 (2/562) | 0.68 (2/293) | 0 | 0 |
Live birth measured by multivariate logistic regression with stratification analysis
Before matching | After matching | |||
---|---|---|---|---|
Adjusted OR (95% CI) |
P
| Adjusted OR (95% CI) |
P
| |
Total | 1.88 (1.28, 2.77) | 0.001 | 1.86 (1.13, 3.05) | 0.02 |
Age (year) | ||||
< 35 | 1.95 (1.28, 2.96) | < 0.01 | 1.95 (1.14, 3.34) | 0.02 |
≥ 35 | 0.76 (0.18, 3.21) | 0.72 | 0.67 (0.10, 4.50) | 0.68 |
BMI (kg/m2) | ||||
< 24 | 2.37 (1.46, 3.84) | < 0.001 | 2.08 (1.14, 3.80) | 0.02 |
≥ 24 | 1.24 (0.63, 2.47) | 0.53 | 1.54 (0.61, 3.85) | 0.36 |
AMH (ng/ml) | ||||
< 1.2 | 0 | 1.00 | 0 | 1.00 |
1.2 ≤ AMH < 4.5 | 1.75 (1.00, 3.04) | 0.05 | 1.81 (0.93, 3.52) | 0.08 |
≥ 4.5 | 2.68 (1.30, 5.53) | < 0.01 | 4.19 (1.53, 11.43) | < 0.01 |