Live Birth Outcomes for PCOS Patients Under Depot Agonist Protocol or Antagonist Protocol - a retrospective Chinese cohort

Abstract Research question：When polycystic ovary syndrome (PCOS) patients undergo in vitro fertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET) and embryo transfer (ET), popular protocols include gonadotropin-releasing hormone agonist (GnRH-a) long protocol, GnRH antagonist protocol, and depot GnRH agonist protocol. There is no consensus regarding which protocol is the most optimal for PCOS patients, so we sought to evaluate depot GnRH agonist protocol versus GnRH antagonist protocol in terms of IVF outcome for PCOS patients in a single fertility center.Design：In this retrospective cohort, we included 533 PCOS patients who were undergoing their first IVF cycle. Among them, 470 were in the depot agonist group and 63 in the antagonist group. Fresh live birth rate (LBR) was the primary outcome. The secondary outcome was cumulative live birth rate (CLBR).Results：Women in the depot GnRH agonist group had a higher LBR (49.79%) than those in the antagonist group (34.92%), p=0.027. Multi-variable logistic regression showed that women in the depot GnRH agonist group had a higher LBR than those in the antagonist group (OR=1.83, p=0.032, 95% CI 1.05~3.18). After propensity score matching (PSM), the LBR in the depot GnRH agonist group was higher (50.32%) than that of the antagonist group (35.48%), p=0.033. Multi-variable logistic regression showed that women in the depot GnRH agonist group had a higher CLBR than those in the antagonist group (OR=1.77, p=0.038, 95% CI 1.03, 3.04). After PSM, CLBR in the depot GnRH agonist group was higher (60.00%) than that of the antagonist group (46.77%), p=0.054. Six patients (9.52%) in the antagonist group and 35 patients (7.45%) in the depot GnRH agonist group had ovarian hyper-stimulation syndrome (OHSS).Conclusions：In our experience, depot GnRH agonist can provide higher LBR and CLBR than the antagonist protocol can. Meanwhile, OHSS can be controlled at a satisfactory level for safe participation in both protocols.