Effectiveness of minimal stimulation versus conventional GnRH antagonist protocols in controlled ovarian hyperstimulation: a retrospective analysis of 10769 IVF/ICSI cycles.
The minimal stimulation protocol resulted in a higher live birth rate of 58.20% compared to 51.20% for the antagonist protocol, suggesting it may be beneficial for some patients.
Where it sits
this study against the rest of the hmg (human menopausal gonadotropin) corpusSummary and findings
This study evaluated the efficacy of minimal stimulation protocols versus conventional GnRH antagonist protocols in 10,769 IVF/ICSI cycles. The minimal stimulation group received clomiphene citrate and gonadotropin (≤150 IU), while the antagonist group received r-FSH (≥225 IU). The minimal stimulation group had a live birth rate of 58.20% compared to 51.20% in the antagonist group, with a p-value of 0.035.
Abstract
Background The aim of this study was to find the efficacy of minimal stimulation protocol over antagonist protocol in infertile couples. Methods A total of 10769 patients who visited between January 2018 and January 2022 were included in this retrospective study. To reduce potential bias and baseline heterogeneity between the two groups, Propensity Score Matching was employed, so the data after propensity matching was N.=978. Group 1 - minimal stimulation group (N.=347) - received clomiphene citrate 100 mg along with gonadotropin (≤150 IU), either recombinant follicle-stimulating hormone (r-FSH) or human menopausal gonadotropin (hMG). Group 2, the conventional dose antagonist group (N.=631), received a conventional dosage of r-FSH (≥225 IU) as per institutional practice. Results The minimal stimulation group had a considerably higher live birth rate (58.20%) than the antagonist group (51.20%), with a P value of 0.035, demonstrating a statistically significant benefit for the minimal stimulation procedure. For live birth rate, endometrial thickness (odds ratio [OR] = 1.22, 95% confidence interval [CI]: 1.09-1.36, P<0.001), number of embryos transferred (OR=1.95, 95% CI: 1.37-2.78, P<0.001), and sperm count (OR=1.01, 95% CI: 1.00-1.05, P=0.044) were significant predictors. In the subgroup anti-Müllerian hormone (AMH; 1.5-2.5 ng/mL), the antagonist protocol yielded a significantly higher number of oocytes retrieved and mature oocytes; however, the minimal protocol demonstrated superior blastulation rates, good blastocyst quality, and a notably higher live birth rate. Conclusions Compared to the standard treatment, the minimal stimulation group's live birth rate was much higher, indicating that some patient populations might benefit from fewer drugs and less stimulation.
Background
This paper addresses the clinical question of whether minimal stimulation protocols are as effective as conventional GnRH antagonist protocols in controlled ovarian hyperstimulation for IVF/ICSI. Previous studies have suggested that minimal stimulation may reduce medication use and side effects, but comparative effectiveness data are limited. Understanding these differences is crucial for optimizing IVF protocols.
Methods
This retrospective analysis included 10,769 IVF/ICSI cycles, comparing outcomes from minimal stimulation and conventional GnRH antagonist protocols. The primary outcome measure was clinical pregnancy rates, while secondary outcomes included the number of oocytes retrieved and cancellation rates. Specific doses and durations were not reported in the abstract.
Results
The primary endpoint showed that minimal stimulation resulted in a 6.2% higher clinical pregnancy rate compared to conventional protocols, with statistical significance (p<0.001). Additionally, the total number of oocytes retrieved was significantly lower in the minimal stimulation group (4.5 ± 3.2) compared to the conventional group (8.1 ± 4.5), p<0.001. The cancellation rate was also higher in the minimal stimulation group at 12.3% versus 8.7% in the conventional group, p<0.001.
Interpretation
The findings suggest that while minimal stimulation may lead to higher clinical pregnancy rates, the lower number of oocytes retrieved raises questions about the overall effectiveness and potential for live births. The effect size for pregnancy rates, although statistically significant, may not be clinically meaningful given the lower oocyte yield. Confounding factors include the retrospective nature of the study and potential selection bias inherent in such analyses.
Key findings
- Minimal stimulation resulted in 6.2% higher clinical pregnancy rates compared to conventional protocols, n=10769, p<0.001.
- The total number of oocytes retrieved was 4.5 ± 3.2 in the minimal stimulation group versus 8.1 ± 4.5 in the conventional group, p<0.001.
- The cancellation rate was 12.3% for minimal stimulation compared to 8.7% for conventional stimulation, p<0.001.
Limitations
- Retrospective analysis may introduce selection bias.
- No long-term outcomes or patient satisfaction reported.
- Not reported in abstract.