title: Prognostic factors associated with clinical pregnancy in in vitro fertilization using pituitary down-regulation with depot and daily low-dose luteal phase gonadotropin releasing hormone agonists: A single center's experience.
abstract: OBJECTIVE
  To review the experience on depot-dose, and daily low-dose gonadotropin releasing hormone agonist (GnRHa) long protocols and identify prognostic factors.
  
  
  METHODS
  A chart review was conducted on 2106 depot and 1299 daily low-dose cycles at a university hospital.
  
  
  METHODS
  Clinical parameters were summarized, and prognostic factors of clinical pregnancy for each protocol were identified by logistic regressions. Missing data were imputed using multiple imputations (MI) and the regression models were rerun after MI.
  
  
  RESULTS
  Clinical pregnancy rate was 57.5% and 46.9% in the depot and daily low-dose groups, respectively. Logistic regressions with MI identified age (odds ratio [OR]: 0.95, 95% confidence interval [CI]: 0.92-0.98), serum progesterone (OR: 0.62, 95% CI: 0.45-0.84) and endometrial thickness (OR: 1.06, 95% CI: 1.02-1.12) on human chorionic gonadotropin (hCG) day, number of oocytes retrieved (OR: 1.04, 95% CI: 1.01-1.06), fertilization rate (OR: 2.66, 95% CI: 1.46-4.87) and ratio of good-quality D3 embryos (OR: 4.31, 95% CI: 2.79-6.67) as prognostic factors in the depot group. Age (OR: 0.95, 95% CI: 0.92-0.98), endometrial thickness on hCG day (OR: 1.09, 95% CI: 1.03-1.15), ratio of good quality D3 embryos (OR: 2.56, 95% CI: 1.59-4.13) and the number of cryopreserved embryos (OR: 1.07, 95% CI: 1.003-1.15) are prognostic for the daily low-dose protocol. Some regression coefficients that are significant under model-wise deletion become nonsignificant after MI.
  
  
  CONCLUSIONS
  Age, embryo quality and endometrial thickness on hCG day are important prognostic factors for both 1.0/1.3 mg depot and 0.05/0.1 mg daily low-dose luteal phase GnRHa long protocols. MI is a valuable tool to gauge and address bias caused by missing data in reproductive medicine.
authors.affiliation: Reproductive Medicine Research Center of the Sixth Affiliated Hospital, Sun Yat Sen University, Tianhe District, Guangzhou, Guangdong 510620, China.
authors.forename: Caiyun
authors.initials: C
authors.lastname: Liao
authors.affiliation: Reproductive Medicine Research Center of the Sixth Affiliated Hospital, Sun Yat Sen University, Tianhe District, Guangzhou, Guangdong 510620, China.
authors.forename: Rui
authors.initials: R
authors.lastname: Huang
authors.affiliation: Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland 21205, USA.
authors.forename: Roberta W
authors.initials: RW
authors.lastname: Scherer
authors.affiliation: Reproductive Medicine Research Center of the Sixth Affiliated Hospital, Sun Yat Sen University, Tianhe District, Guangzhou, Guangdong 510620, China.
authors.forename: Xiao-Yan
authors.initials: XY
authors.lastname: Liang
keywords: Controlled ovarian stimulation; gonadotropin releasing hormone agonist; missing data; multiple imputations; pituitary down-regulation
references.citation: Hum Reprod. 2011 Sep;26(9):2532-40
references.pmid: 21771773
references.citation: Arch Gynecol Obstet. 2012 Feb;285(2):535-40
references.pmid: 21853250
references.citation: Eur J Obstet Gynecol Reprod Biol. 2004 Jul 1;115 Suppl 1:S40-3
references.pmid: 15196715
references.citation: Hum Reprod. 2009 May;24(5):1085-91
references.pmid: 19176542
references.citation: Fertil Steril. 2012 Sep;98(3):664-670.e2
references.pmid: 22704632
references.citation: Hum Reprod. 1998 Jul;13(7):1788-92
references.pmid: 9740424
references.citation: Reprod Biomed Online. 2005 May;10(5):628-32
references.pmid: 15949221
references.citation: Fertil Steril. 2000 Jun;73(6):1155-8
references.pmid: 10856474
references.citation: Hum Reprod. 2011 Jul;26(7):1813-25
references.pmid: 21540246
references.citation: Hum Reprod. 2010 Aug;25(8):2092-100
references.pmid: 20539042
references.citation: Hum Reprod. 2009 Sep;24(9):2104-13
references.pmid: 19493872
references.citation: Fertil Steril. 2013 Jun;99(7):1905-11
references.pmid: 23522806
references.citation: BMJ. 2006 May 6;332(7549):1080
references.pmid: 16675816
references.citation: Proc Natl Acad Sci U S A. 2010 Aug 3;107(31):13570-5
references.pmid: 20643955
references.citation: Fertil Steril. 2000 Feb;73(2):325-9
references.pmid: 10685537
references.citation: Cochrane Database Syst Rev. 2013 Jan 31;(1):CD002808
references.pmid: 23440788
references.citation: J Clin Epidemiol. 2006 Oct;59(10):1087-91
references.pmid: 16980149
references.citation: Gynecol Endocrinol. 2013 Sep;29(9):846-50
references.pmid: 23865696
references.citation: Am J Epidemiol. 1995 Dec 15;142(12):1255-64
references.pmid: 7503045
references.citation: J Assist Reprod Genet. 1996 Mar;13(3):207-11
references.pmid: 8852880
references.citation: J Hum Reprod Sci. 2012 Jan;5(1):14-9
references.pmid: 22870009
references.citation: Mol Aspects Med. 2014 Aug;38:54-85
references.pmid: 23796757