Clinical outcomes of the short agonist stop protocol versus the long GnRH agonist protocol in poor ovarian responders undergoing IVF/ICSI: a retrospective analysis

OBJECTIVE: To assess the efficacy of the stop GnRH agonist/GnRH antagonist (STOP) protocol in improving in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) outcomes in patients with poor ovarian response (POR). METHODS: Patients with POR who underwent IVF or ICSI at the Reproductive Center of Shanxi Women and Children Hospital between January 2023 and April 2024 were retrospectively enrolled according to the Bologna criteria for POR established by the European Society of Human Reproduction and Embryology in 2011. All received controlled ovarian stimulation (OS) and were assigned to a control group, which underwent the conventional short-acting long protocol, or the STOP group. Ovulation induction parameters and clinical outcomes were compared to assess the effectiveness of the STOP protocol. RESULTS: A total of 103 patients were included in the study. Analysis of controlled OS characteristics demonstrated that the duration of stimulation was significantly longer in the STOP group than in the control group (P < 0.05). Luteinizing hormone (LH) and estradiol levels on the day of human chorionic gonadotropin (hCG) administration, as well as LH levels on the day of gonadotropin (Gn) initiation, were significantly higher in the STOP group than in the control group (P < 0.05). No significant differences were observed between the groups in the total Gn dose administered or the number of follicles ≥ 16 mm on the day of hCG administration (P > 0.05). Retrieved oocytes and metaphase II (MII) oocytes were significantly higher in the STOP group (P < 0.05). However, no significant differences were found between the two groups in clinical outcomes, including implantation rate, clinical pregnancy rate, and miscarriage rate (P > 0.05). CONCLUSION: The STOP protocol effectively increases the numbers of retrieved oocytes and MII oocytes in patients with POR. However, it does not significantly improve embryo development outcomes or clinical pregnancy outcomes.