To compare the clinical outcome of improved short protocol with gonadotropin-releasing hormone agonist (GnRH-a) and progestin primed ovarian stimulation (PPOS) in aged patients (age≥ 35 years) with diminished ovarian reserve (the number of antral follicles<8).

A retrospective analysis was performed on 340 cycles of aged patients with diminished ovarian reserve who received in vitro fertilization (IVF)/intracytoplasmic sperm injection and embryo transfer (ICSI-ET) from January 2016 to September 2017 at the Reproductive Center of Xiangtan Central Hospital. According to the program of controlled ovulation, the patients were divided into either an improved short protocol group (175 cycles) or a PPOS group (165 cycles). The outcome of controlled ovulation induction and clinical outcomes of the two groups were analyzed. Gonadotropin (Gn) dosage, Gn days, number of transplantable embryos, and drug cost in the two groups were compared by the t-test. The rate of 2PN fertilization, rate of good embryo implantation, clinical pregnancy rate, live birth rate, embryo loss rate, ectopic pregnancy rate, and abortion rate between the two groups were compared by the χ² test.

Gn dosage in the PPOS group was significantly lower than that in the short protocol group [(2736.0±633.6) U vs (2204.6±1539.4) U, t=4.516, P<0.001]. The duration of Gn use was significantly shorter in the PPOS group than in the improved short protocol group [(10.34±2.00) days vs (9.45±1.75) days, t=5.125, P<0.001], and the cost of ovulation induction was lower in the PPOS group than in the improved short protocol group [(843.73±273.43) yuan vs (650.22±450.52) yuan, t=6.755, P<0.001]. The number of oocytes retrieved [(4.88±2.21) vs (4.01±2.39), t=4.507, P=0.001] and the number of transplantable embryos [(3.35±1.81) vs (2.90±1.92), t=3.302, P=0.005] in the improved short protocol group were significantly higher than those in the PPOS group. For clinical outcomes, the implantation rate of the improved short protocol group [23.69% (95/401) vs 14.01%(36/257), χ²=9.210, P=0.002] was significantly higher than that in the PPOS group, and the improved short protocol group tended to have a higher cumulative pregnancy rate [37.62% (79/210) vs 27.62% (29/105), χ²=3.107, P=0.078] and live birth rate [22.38% (47/210) vs 17.14% (18/105), χ²=1.173, P=0.179], although the difference was not significant (P>0.05). The differences in abortion rate [3.33% (7/210) vs 1.90% (2/105), χ²=0.475, P=0.723] and ectopic pregnancy rate [1.90% (4/210) vs 0.95% (1/105), χ²=0.443, P=0.668] did not differ significantly between the two groups.

Compared with PPOS, the improved short protocol with GnRH-a can achieve satisfactory oocyte retrieval, transplantable embryo, implantation rate, and clinical pregnancy rate. Therefore, the improved short protocol with GnRH-a is a new choice for elderly patients with diminished ovarian reserve.