Abstract: Objective To compare the clinical outcomes and cost-effectiveness of luteal phase down-regulation with
gonadotrophin-releasing hormone (GnRH) agonist protocol and GnRH antagonist protocol in patients undergoing repeated in
vitro fertilization and intracytoplasmic sperm injection (IVF-ICSI) cycles. Methods A retrospective analysis of clinical outcomes
and costs was conducted among 198 patients undergoing repeated IVF-ICSI cycles, including 109 receiving luteal phase
down-regulation with GnRH agonist protocol (group A) and 89 receiving GnRH antagonist protocol (group B). The numbers
of oocytes retrieved and good embryos, clinical pregnancy rate, abortion rate, the live birth rate, mean total cost, and the
cost-effective ratio were compared between the two groups. Results In patients undergoing repeated IVF-ICSI cycles, the two
protocols produced no significant differences in the number of good embryos, clinical pregnancy rate, abortion rate, or twin
pregnancy rate. Compared with group B, group A had better clinical outcomes though this difference was not statistically
significant. The number of retrieved oocytes was significantly greater and live birth rate significantly higher in group A than in
group B (9.13±4.98 vs 7.11±4.74, and 20.2% vs 9.0%, respectively). Compared with group B, group A had higher mean total cost
per cycle but lower costs for each oocyte retrieved (2729.11 vs 3038.60 RMB yuan), each good embryo (8867.19 vs 9644.85 RMB
yuan), each clinical pregnancy (77598.06 vs 96139.85 RMB yuan). Conclusion For patients undergoing repeated IVF/ICSI cycle,
luteal phase down-regulation with GnRH agonist protocol produces good clinical outcomes with also good cost-effectiveness
in spite an unsatisfactory ovarian reserve.