Effects of changing the COS protocol in patients without a transplantable embryo in the previous IVF/ICSI cycle

Objective: Some patients fail to obtain an embryo for transplantation during previous in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) cycles, and require multiple reproductive treatments. This study aimed to evaluate whether changing the control ovarian stimulation (COS) protocol during the subsequent stimulation cycle could improve laboratory and clinical outcomes in these patients. Methods: Patients without a transplantable embryo (TE) in the previous IVF/ICSI cycles were recruited during their second cycles. They were classified into two groups according to their first cycle protocol: Group A, patients treated with a gonadotropin-releasing hormone agonist (GnRH-a), and Group B, patients treated with a gonadotropin-releasing hormone antagonist (GnRH-ant). The study group included patients whose stimulation protocols were changed, whereas the control group consisted of patients who used the same stimulation protocol in the second cycle. We then compared the numbers of oocytes collected (OC) and TE, the incidence of non-TE, the pregnancy rate (PR), and the live birth rate (LBR). Results: In Group A, the numbers of OC and TE were significantly lower (6.0 ± 4.7 vs . 9.4 ± 6.4, 2.3 ± 2.2 vs . 4.5 ± 3.8, P <0.05) in the study group compared with those in the control group. In Group B, the numbers of OC and TE were higher (7.0 ± 5.5 vs . 4.0 ± 4.3, 3.5 ± 3.4 vs . 1.8 ± 2.1, P <0.05) in the study group. There was a significant increase in the incidence of non-TE (adjusted odds ratio (AOR) = 2.12, 95% CI: 1.04–4.69) of the study group in Group A but not in Group B. No significant differences in the PR or LBR were found between the study and control groups in either Group A or B. Conclusion: Changing the COS protocol from GnRH-ant to GnRH-a or continuing the GnRH-a protocol can improve laboratory outcomes in patients with no TE in the previous IVF/ICSI cycle.