Background At present, the number of women with infertility seeking assisted reproductive technology due to diminished ovarian reserve increases gradually. However, there are few discussions on the clinical application of pure urinary gonadotropin in patients with diminished ovarian reserve at an advanced age.
Objective To investigate the clinical effect of different ovulation promotion schemes in women of advanced maternal age with clinical dysfunction during assisted reproduction on in vitro fertilization-embryo transfer (IVF-ET).
Methods A total of 384 cycles (IVF/ICSI) of women of advanced maternal age with DOR who received IVF-ET for pregnancy in the Sixth Medical Center of Chinese PLA General Hospital from January 2021 to December 2022 were retrospectively collected. The women were divided into pure urinary gonadotropin group and antagonist group according to different ovulation stimulating regimens. The general clinical indexes, clinical outcomes of ovulation induction cycle and transplantation cycle were compared between the two groups.
Results The difference in the mean age between the pure urinary gonadotropin group (184 cycles) and the antagonist group (178 cycles) was not statistically significant (39.1 ± 4.6 years vs 40.0 ± 4.1 years, P=0.055). Besides, there were no significant differences in the general clinical indicators such as BMI, infertility years, basic FSH value, basic LH value, AMH between the two groups (P>0.05). The number of transplant failure in the pure urinary gonadotropin group was significantly higher than that in the antagonist group (1.4 ± 0.1 vs 1.0 ± 0.1, P=0.023). In the cycle of ovulation induction medication, compared with the antagonist group, the pure urinary gonadotropin group had a significantly lower total dosage of ovarian stimulation drugs (1654.33 ± 1028.64 U vs 1934.03 ± 1015.87 U, P=0.009), and a significantly shorter duration of ovarian stimulation (8.3 ± 4.0 d vs 9.1 ± 2.9 d, P=0.02). Besides, the LH level on trigger day (10.10 ± 8.50 IU/L vs 5.41 ± 4.68 IU/L, P<0.01) and the high-quality embryo rate of the pure urinary gonadotropin group (87.0% vs 80.5%, P=0.039) were higher than those of the antagonist group, and the differences were statistically significant. In the subsequent transplantation cycle, there were no significant differences in the good-quality embryo transfer rate (77.3% vs 87.1%, P=0.061), clinical pregnancy rate (26.6% vs 24.6%, P=0.789) and live birth rate (57.1% vs 60.0%, P=0.852) between the two groups in the frozen-thawed embryo transfer cycles. At the same time, there were no significant differences in the good-quality embryo transfer rate (78.1% vs 76.5%, P=0.861), clinical pregnancy rate (31.3% vs 31.3%, P>0.999) and live birth rate (60.0% vs 50.0%, P=0.714) in the fresh embryo transfer between the two groups.
Conclusion The pure urinary gonadotropin program in the ovulation cycle of women of advanced maternal age with diminished ovarian reserve can increase the high-quality embryo rate, reduce the dosage and the number of days of medication, which has certain clinical application value.
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