Analyzing the SART CORS Database: The Agonist Suppression Protocol is Superior to Antagonist Suppression and Co-flare Protocols in Women with Diminished Ovarian Reserve

OBJECTIVE: To assess the association between number of oocytes retrieved for women with diminished ovarian reserve (DOR) comparing the agonist suppression (Ago), antagonist suppression (Ant), and co-flare (Cof) protocols. STUDY DESIGN: Using the Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) data from 2014, a total of 9,569 patient cycles met criteria for DOR based on anti-Mullerian hormone (AMH) < 0.5 ng/mL and/or follicle-stimulating hormone > 14 IU/L. Duplicate patient cycles were excluded, leading to a total of 3,306 cycles to analyze. The 3 stimulation protocols compared were Ago, Ant, and Cof. The number of oocytes retrieved was analyzed utilizing Poisson regression adjusting for age and body mass index (BMI). Analysis of transfer attempted was analyzed with standard logistic regression adjusting for age, BMI, and insemination method. RESULTS: Baseline characteristics were similar for the 3 protocols, with modest differences noted in average age, AMH levels, and diagnosis of DOR. Oocytes retrieved were found to be highest among the Ago protocol, with retrieval of 6 oocytes as compared to 5 and 4 with the Ant and Cof protocols, respectively. When adjusting for age and BMI, the relative risk of increased oocytes retrieved was 1.29 (95% CI 1.18-1.44) and 1.17 (95% CI 1.09-1.25) for Ago and Ant, respectively, p-value < 0.01. When also adjusting for insemination method, the odds of attempting a transfer was 1.56 (95% CI 1.16-2.08) and 0.81 (95% CI 0.67-0.97) for Ago and Ant as compared to Cof protocol. CONCLUSION: Using the SART CORS data from 2014, women with DOR had the greatest number of oocytes retrieved following Ago protocol and were more likely to undergo an embryo transfer when compared to Ant or Cof protocols.