Results
A total of 562 cycles were included in the study with 257 cycles of
fresh ET and 305 cycles of FET. In fresh ET cycles, subgroups were
divided according to COS protocols, cycles of ultra-long, long,
antagonist and short protocols were respectively 108, 56, 34 and 59. In
EFT cycles, subgroups were ascertained according to different embryos
origins, cycles of ultra-long, long, antagonist and short protocols were
98, 101, 54 and 52.
The characteristics of adenomyosis population in fresh ET was shown inTable I . Except for BMI, there were significant differences in
age, duration of infertility, primary infertility, AFC, FSH, AMH, mean
diameter of initial uterus and dysmenorrhea history in intragroup
comparisons. The differences mainly concentrated on the comparisons
between short protocol and other protocols. Compared with ultra-long,
long and antagonist protocols, short protocol had older maternal age
(37.00 versus 34.00, 32.50, 33.50, P=0.001), poorer AMH (1.30 versus
1.65, 2.75, 1.31, P<0.001) and lower AFC (9.0 versus 11.00,
13.00, 10.00). Compared with ultralong, antagonist and short protocols,
long protocol had the highest AMH (2.75 versus 1.65, 1.32, 1.30,
P<0.001) and the minimal uterine volume (5.43 versus 6.22,
6.05, 5.45, P<0.001). The proportion of severe dysmenorrhea in
ultra-long protocol was highest (37.96% versus 17.86%, 11.76%,
13.56%). In terms of the comparisons among ultra-long, long and
antagonist protocols, no significant differences existed in age, BMI,
duration of infertility, primary infertility and FSH.
COS related parameters and pregnancy outcomes were shown inTable II . Compared with long, antagonist and short protocols,
gonadotropin duration (11.00 versus 9.00, 9.00, 9.00, P
<0.001) and gonadotropin dosage (2775.00 versus 1800.00,
2175.00, 1975.00, P <0.001) obviously increased in ultra-long
protocol. Compared with ultra-long, long and antagonist protocols,
endometrial thickness on HCG trigger day was thinnest (0.9 versus 1.1,
1.1, 1.0, P=0.002) and the number of retrieved oocytes was lowest (4.00
versus 7.00, 10.00, P<0.001) in short protocol. However, no
statistical significance existed among intragroup comparisons of
ultra-long, long and antagonist protocols. As to high-quality embryos on
day 3, long protocol had more good embryos compared with ultra-long,
antagonist and short protocols (4.00 versus 2.00, 2.00, 2.00,
P<0.001).
The parameters of pregnancy outcomes included IR, BPR, EPR, CPR, MR,
early MR and late MR and LBR. Compared with ultra-long and long
protocols, IR (28.2% versus 49.7%, 52.1%, P=0.001) and CPR (35.6%
versus 64.3%, 57.4%, P=0.004) in short protocol significantly
decreased. The decrease of IR (33.3% versus 49.7%, 52.1%) and CPR
(38.2% versus 57.4%, 64.3%) also existed in antagonist protocol,
although no statistical significance was detected because of strict P
adjustment of Bonferroni method (Padj=0.008). LBR in ultra-long, long,
antagonist and short protocols was respectively 39.8%, 48.2%, 26.5%
and 20.3%. Compared with long protocol, LBR in short protocol decreased
obviously (48.2% versus 20.3%, P<0.001). LBR in antagonist
protocol was also pessimistic (48.2% versus 26.5%), although no
statistical significance. There were no significant differences in
intragroup comparisons of BPR, MR, early MR and late MR.
Considering the differences of baseline parameters among four protocols,
we carried out CPR and LBR associated multiple factors logistic
analysis, which was shown in Table III and IV. When CPR was set
as the outcome variable, after adjusting age, BMI, FSH, AFC, AMH,
initial uterus diameter and dysmenorrhea history, we observed that long
protocol was a protective factor compared with short protocol (OR 2.414,
95% CI 1.011-1.144, P=0.047). AFC was also a protective factor (OR
1.073, 95% CI 1.007-5.767, P=0.030), and the main risk factor was age
(OR 1.073, 95% CI 1.007-5.767, P<0.001). When LBR was set as
the outcome variable, after adjusting similar independent factors,
ultra-long (OR 2.47, 95% CI 1.005-6.07, P=0.049) and long protocol (OR
2.786, 95% CI 1.055-7.353, P=0.039) were both protective factors
compared with short protocol. Secondary infertility (OR 2.088, 95% CI
1.018-4.283, P=0.045) and AFC (OR 1.069, 95% CI 1.001-1.142, P=0.047)
were also protective factors. Age (OR 0.809, 95% CI 0.743-0.882,
P<0.001) was still a risk factor.
In FET cycles, we summarized baseline data of frozen embryo originating
COS cycles, which was shown in Table V . Similar to
characteristics in fresh ET cycles, compared with ultra-long, long and
antagonist protocols, short protocol had older age (37.00 versus 33.00,
31.00, 33.00, P<0.001) and lower AMH (1.35 versus 2.84, 4.17
and 4.07, P<0.001). Age, BMI, duration of infertility, primary
infertility, AFC, FSH and AMH had no statistical difference among
ultra-long, long and antagonist protocols. The related parameters of
frozen embryo originating COS protocols and pregnancy outcomes were
shown in Table VI. Compared with long, antagonist and short
protocols, gonadotropin dosage (2512.50 versus 2025.00, 1875.00 and
2025.00, P<0.001) and gonadotropin stimulation duration (11.00
versus 10.00, 9.00, 9.00, P<0.001) significantly increased in
ultra-long protocol. Ultra-long and long protocol had higher E2 level on
HCG trigger day compared with short protocol (3117.00, 3000.00 versus
2131.50, P<0.001). No significant differences in progesterone
level (P=0.542) and endometrial thickness (P=0.676) on HCG trigger day
existed among four protocols. The number of retrieved oocytes (6.5
versus 12.00, 12.00, 11.00, P<0.001) and 2PN zygotes (4.00
versus 7.00, 8.00 6.50, P<0.001) in short protocol were
significantly lower than those in ultra-long, long and antagonist
protocols. Absolutely different from fresh ET cycles, no statistical
differences among ultra-long, long, antagonist and short protocols on IR
(45.5%, 47.2%, 41.8%, 50.0%, P=0.851), BPR (12.2%, 6.9%,
5.6%,13.5%, P=0.313), CPR (43.9%, 49.5%, 40.7%, 50.0%, P=0.658),
MR (42.9%,32.7%, 47.6%, 38.5%, P=0.626), early MR (27.9%,
32.0%,36.4%, 30.8%, P=0.917), late MR (14.3,-,9.5%,7.7%,P=0.76) and
LBR (24.7%, 33.0%, 20.8%, 30.8%, P=0.343) were detected.