A Modified Ultra-Long Downregulation Protocol Improves Pregnancy Outcomes in High Body Mass Index Patients UndergoingFertilization/Intracytoplasmic Sperm Injection Treatment

摘要

Objective:Overweight and obesity are increasingly epidemic and negatively related to reproductive outcome.The aim of this study was to investigate the advantages of a modified ultra-long downregulation protocol on pregnancy outcomes of patients with high body mass index(BMI)undergoingin vitro fertilization(IVF)/intracytoplasmic sperm injection(ICSI),compared to the long protocol(LP).Methods:We retrospectively analyzed the clinical data of 3,920 infertile patients at the Reproductive and Genetic Hospital of Citic-Xiangya from January 2012 to December 2017 by propensity score matching(PSM).Patients were divided into two groups:modified ultra-LP(MULP)(n=1,960)and LP(n=1,960).Results:In the MULP group,live birth rate(52.65%vs.46.79%,P<0.001,odds ratio[OR]:1.784,95%confidence interval[CI]:1.563-2.036),clinical pregnancy rate(62.50%vs.57.91%,P=0.003,OR:1.211,95%CI:1.066-1.377),and implantation rate(53.24%vs.49.65%,P=0.004,OR:1.155,95%CI:1.048-1.272)were statistically significantly higher than those of the LP group.Moreover,the cycle cancellation rates(12.70%vs.15.15%,P=0.027,OR:0.815,95%CI:0.68-0.977),abortion rates(12%vs.14.8%,P=0.046,OR:0.785,95%CI:0.619-0.996),and ectopic pregnancy rates(1.06%vs.2.11%,P=0.04,OR:0.497,95%CI:0.252-0.98)were lower than those in the LP group.Conclusion:The modified ultra-long downregulation protocol improved the pregnancy outcomes in patients with high BMI undergoing IVF/ICSI treatment,providing a potential option for physicians when deciding an optimized ovary stimulation protocol for high BMI patients.