Abstract
Objective GnRH-antagonist protocols have garnered significant attention due to their potential to yield more favorable pregnancy outcomes. The association between clinical parameters of GnRH-antagonist protocols and pregnancy outcomes in fresh embryo transfer cycles is a major area of concern. Therefore, our study aimed to investigate the relationship between clinical parameters and pregnancy outcomes in GnRH-antagonist protocols. Methods Out of 2800 couples, we conducted a retrospective evaluation of 442 women, aged 22–40 years, who underwent embryo transfer in-vitro fertilization (IVF) with GnRH-antagonist protocols. Our focus was on the pregnancy outcomes in the fresh embryo transfer cycle of cleavage-stage. The participants were divided into pregnancy (n = 161) and non-pregnancy groups (n = 281), and their clinical parameters were compared to investigate which factors had an effect on pregnancy outcome using a binary logistic regression model. Results Using the Mann-Whitney test, it was determined that several factors were significantly different between the pregnant and non-pregnant groups. Specifically, anti-mullerian hormone (AMH) (p = 0.031 < 0.05), antral follicle count (AFC) (p = 0.000 < 0.05), number of oocytes retrieved (p = 0.002 < 0.05), Metaphase II (MIl) (p = 0.011 < 0.05), Two pronuclear (2PN) (p = 0.014 < 0.05), and endometrial thickness at transplantation (p = 0.045 < 0.05 ) were all found to be significantly greater in the pregnant group compared to the non-pregnant group. Furthermore, AFC (OR = 1.046, 95% confidence interval (CI):1.019–1.073, p = 0.000 < 0.05) and AMH (OR = 1.078 ,95% CI:1.013–1.013, p = 0.031 < 0.05 ) were positively associated with pregnancy outcome. It was also observed that AFC (AUC = 0.600, 95%CI:0.545–0.656,p = 0.002 < 0.05) and AMH (AUC = 0.562, 95%CI:0.507–0.616,p = 0.002 < 0.05) had weak predictive power for pregnancy outcome in GnRH-antagonist protocols, however, their predictive power was stronger when AFC was greater than 15 (AUC = 0.753, 95%C1:0.587–0.799,p = 0.002 < 0.05) and AMH levels were greater than 4.0 ng/mL in the group (AUC = 0.602, 95%C1:0.502–0.702, p = 0.033 < 0.05). Additionally, AFC was found to be more relevant and predictive of pregnancy outcome than AMH in GnRH-antagonist protocols. Conclusions: AFC and AMH levels have limited predictive value in predicting pregnancy outcomes with GnRH-antagonist protocols, but they demonstrate significant clinical utility when AFC exceeds 15 and AMH is above 4.0 ng/mL. This discovery holds significant predictive value for clinicians utilizing AFC and AMH to assess pregnancy outcomes in patients with high ovarian reserve undergoing GnRH-antagonistic cycles.