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This research aims to compare clinical pregnancy outcomes between GnRH-a and antagonist protocols for fresh embryo transfer in young patients with poor prognosis.

June 28, 2026Open Access

Comparing the clinical pregnancy outcomes of fresh embryo transfer in young patients with poor prognosis using different ovarian stimulation protocols

Key Points

This research aims to compare clinical pregnancy outcomes between GnRH-a and antagonist protocols for fresh embryo transfer in young patients with poor prognosis.
Retrospective cohort study on women under 35 years with AMH levels < 1.2 ng/ml undergoing IVF-ET.
1,732 cycles with GnRH-a and 3,168 cycles with antagonist protocols were analyzed, followed by 1:1 propensity score matching.
Multivariate logistic regression was utilized to assess clinical outcomes.
GnRH-a group had a higher clinical pregnancy rate of 55.01% (P = 0.003) compared to 47.67% in the antagonist group.
GnRH-a group showed a significantly higher live birth rate of 41.66% (P < 0.001) versus 31.74% in the antagonist group.
Reduction in transfer cancellation rates was observed in the GnRH-a group (34.67%, P < 0.001) compared to antagonist (45.71%).

Abstract

To evaluate the clinical pregnancy outcomes of fresh embryo transfer at the cleavage stage utilizing gonadotropin-releasing hormone agonist (GnRH-a) and the antagonist protocols in young patients with poor prognosis. A retrospective cohort study was carried out on patients who underwent in vitro fertilization-embryo transfer (IVF-ET) between January 2016 and July 2024. Women under 35 years old with anti-Müllerian hormone (AMH) levels 0.05). Multivariate logistic regression analysis revealed that the clinical pregnancy rate in the GnRH-a group (OR = 1.25,95%CI:1.02, 1.52) was 1.25 times higher than that in the antagonist group ( P = 0.0297), and the live birth rate(OR = 1.38,95%CI:1.12, 1.71) was 1.38 times higher ( P = 0.0025). Additionally, compared to the antagonist group (transfer cancellation rate: 45.71%; total embryo freezing: 31.58%), the GnRH-a group exhibited reduced rates of fresh cycle transfer cancellation (34.67%; P 0.05). In young patients with poor prognosis, the GnRH-a protocol for controlled ovarian stimulation in fresh embryo transfer cycles produces higher clinical pregnancy and live birth rates, as well as a lower fresh transfer cancellation rate, as compared to the antagonist protocol.

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