{"paper_id":"7647c3b0-a801-4d6d-86b9-74b6fcfb1b21","body_text":"Comparison of the Follicular Long-Acting Long Protocol and Antagonist Protocol in Infertile Patients with Hyperlipidemia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comparison of the Follicular Long-Acting Long Protocol and Antagonist Protocol in Infertile Patients with Hyperlipidemia Xuhui Zhang, Ge Song, Xiaoling Zhang, Yinjing Dong, Yaonan Cao, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9481660/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Objective To investigate the application effects and fresh cycle pregnancy outcomes of the follicular long-acting long protocol and antagonist protocol in infertile patients with hyperlipidemia. Methods A retrospective analysis was conducted on the clinical data of 621 infertile patients with hyperlipidemia who underwent IVF/ICSI treatment at the Reproductive Medicine Center of our hospital from January 2021 to December 2023. Patients were divided into the follicular long-acting long protocol group (n = 195) and the antagonist protocol group (n = 426) based on the ovarian stimulation protocol. The baseline characteristics, ovulation induction and fresh cycle transplantation were compared between the two groups, and the main factors for pregnancy outcome such as age, body mass index (BMI), high-quality embryos transplantation, and ovulation induction protocols were evaluated by Logistic multivariate analysis. Results Compared with the follicular long-acting long protocol group, the antagonist protocol group had older age, longer infertility duration, lower proportion of primary infertility, fewer antral follicle count (AFC), fewer total Gn dosage, shorter gonadotropin (Gn) usage days, fewer retrieved oocytes, lower blastocyst formation rate, and lower incidence of ovarian hyperstimulation syndrome (OHSS) (all P < 0.05). There were no significant differences between the two groups in body mass index (BMI), levels of estradiol (E₂) and progesterone (P) on the day of human chorionic gonadotropin (hCG) administration, endometrial thickness, number of high-quality embryos, proportion of blastocyst transfer, clinical pregnancy rate, live birth rate, miscarriage rate, preterm birth rate, or neonatal weight (all P > 0.05). After adjusting for confounding factors such as age, BMI, and endometrial thickness, Logistic regression analysis showed that age was an independent factor affecting clinical pregnancy rate ( P < 0.05), while the ovarian stimulation protocol had no significant impact on fresh cycle clinical pregnancy rate. Conclusion Similar clinical pregnancy outcomes can be achieved with the follicular long-acting long protocol and antagonist protocol in infertile patients with hyperlipidemia. The antagonist protocol offers advantages such as shorter Gn usage time and lower OHSS risk, making it a preferred option for this population. Hyperlipidemia Follicular long-acting long protocol Antagonist protocol IVF/ICSI Pregnancy outcomes 1. Introduction In recent decades, the global prevalence of hyperlipidemia has been increasing, particularly among women of childbearing age [ 1 ]. Accumulating evidence suggests that hyperlipidemia is closely associated with adverse outcomes in assisted reproductive technology (ART), including impaired ovarian response, compromised oocyte quality, poor endometrial receptivity, and reduced live birth rates [ 2 , 3 ]. Hyperlipidemia triggers oxidative stress and chronic inflammatory reactions in the reproductive system, thereby interfering with follicular development and embryo implantation [ 4 ]. For infertile patients with hyperlipidemia, choosing an appropriate ovarian stimulation protocol is critical to improving therapeutic efficacy and safety. The follicular-phase long-acting long protocol and the antagonist protocol are the two most commonly used ovarian stimulation regimens in clinical ART [ 5 ]. The follicular-phase long-acting long protocol achieves synchronized follicular growth via gonadotropin-releasing hormone agonist (GnRH-a) downregulation, yielding consistent oocyte retrieval but requiring a prolonged treatment duration and high gonadotropin (Gn) dosage [ 6 ]. In contrast, the antagonist protocol starts ovarian stimulation directly and uses GnRH antagonists to prevent premature luteinizing hormone (LH) surges in the mid-follicular phase, with the benefits of a short cycle, favorable safety profile, and low risk of ovarian hyperstimulation syndrome (OHSS) [ 7 ]. Previous studies comparing ovarian stimulation protocols have mainly focused on normolipidemic individuals, with scarce data available for patients with hyperlipidemia [ 8 – 10 ]. Therefore, the optimal ovarian stimulation strategy for infertile patients with hyperlipidemia has not been established. Metabolic disorders caused by hyperlipidemia may interact differently with distinct stimulation regimens and further affect treatment outcomes. This study retrospectively compared the efficacy and pregnancy outcomes between the follicular-phase long-acting long protocol and the antagonist protocol in infertile patients with hyperlipidemia, aiming to provide evidence for individualized protocol selection in clinical practice. 2. Materials and Methods 2.1 Study participants A total of 621 infertile patients with hyperlipidemia who received in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatment at the Reproductive Medicine Center of our hospital from January 2021 to December 2023 were enrolled in this study. The diagnostic criteria for hyperlipidemia were based on the 2016 Guidelines for the Prevention and Treatment of Hyperlipidemia in Chinese Adults [ 11 ]. Hyperlipidemia was defined as the presence of at least one of the following indicators: total cholesterol (TC) ≥ 5.18 mmol/L, low-density lipoprotein cholesterol (LDL-C) ≥ 3.37 mmol/L, high-density lipoprotein cholesterol (HDL-C) < 1.04 mmol/L, and triglycerides (TG) ≥ 1.7 mmol/L. Inclusion criteria were as follows: (1) Age ≤ 43 years; (2) Diagnosed with primary or secondary infertility; (3) Underwent ovarian stimulation using either the follicular-phase long-acting long protocol or the antagonist protocol; (4) Underwent the first fresh cycle embryo or blastocyst transfer; (5) Complete clinical data and clear follow-up of pregnancy outcomes. Exclusion criteria were as follows: (1) Severe hepatic or renal insufficiency, uncontrolled thyroid dysfunction, diabetes mellitus, or hypertension; (2) Premature ovarian insufficiency, endometriosis, uterine malformation, or moderate-to-severe intrauterine adhesions; (3) Donor oocyte cycles or preimplantation genetic diagnosis/screening (PGD/PGS) cycles; (4) Use of lipid-lowering drugs, hormonal agents, or antioxidants within 3 months prior to treatment; (5) Chromosomal abnormalities in either partner; (6) Endometrial thickness < 8 mm on the day of human chorionic gonadotropin (hCG) administration. This study was approved by the Ethics Committee of the Fourth Hospital of Shijiazhuang (Ethics Number: 20240022), and all procedures were performed in accordance with the relevant ethical guidelines. 2.2 Grouping Methods Patients were divided into two groups based on the ovarian stimulation protocol: Follicular long-acting long protocol group (n = 195): On days 20–22 of the menstrual cycle, patients received GnRH-a (Triptorelin, Ipsen France) for downregulation. Ovarian stimulation was initiated with recombinant human FSH (rFSH, Gonal-f, Merck Serono Switzerland) or human menopausal gonadotropin (HMG, Livzon Group China) 14 days later, after confirming successful downregulation (LH < 5 U/L, E₂ <50 pg/mL, follicle diameter < 5 mm).Antagonist protocol group (n = 426): Ovarian stimulation was initiated with rFSH or HMG on day 3 of the menstrual cycle. GnRH antagonist (Cetrorelix, Merck Germany) was added when the leading follicle diameter reached ≥ 12 mm to suppress the LH surge. 2.3 Ovarian Stimulation and ART Procedures Ovulation induction and oocyte retrieval: All patients were treated with long-acting ovulation induction protocols or antagonist protocols during the follicular phase. After 8 to 14 days of ovulation induction, when at least 2 follicles were ≥ 18mm in diameter, or 3 follicles were ≥ 17mm in diameter, 5000 to 10000 U of chorionic gonadotropin (HCG, Zhuhai Livzon, China) or 250 µg of recombinant HCG (Ovitrelle; Merck, Switzerland) was injected intramuscularly to trigger ovulation. 36 to 38 hours after triggering, oocytes were retrieved under vaginal ultrasound guidance and fertilization was performed via conventional IVF or ICSI based on semen quality. All patients underwent fresh cycle transplantation, and 1 to 2 cleavage-stage embryos on the third day (D3) or 1 blastocyst-stage embryos on the fifth day (D5) of the cycle were transplanted according to the patient's age, medical history, and embryo development in this cycle. Luteal support: From the day of oocyte retrieval, all patients were given vaginal sustained-release gel of progesterone (Crinone; Merck Serono, Germany) 90 mg per dose, administered once daily, or soft capsules of progesterone (Utrogestan; Besins Healthcare, France) 0.2 g per dose, administered three times daily. After embryo transplantation, diethylprogesterone tablets (Duphaston; Solvay, the Netherlands) 10 mg per dose were orally administered three times daily. Seven days later, if the blood β-HCG level was > 5 U/L, it was considered HCG positive, and luteal support was continued until 60 days after transplantation, with the dosage gradually reduced before discontinuing the medication. Embryo assessment criteria and pregnancy determination: On the D3, the development and quality of the embryos were evaluated based on the number of cleavage cells, the size of the cleavage cells, and the percentage of fragments. High-quality D3 embryos were defined as those derived from normal fertilization of 2-pronuclear (2PN) fertilized eggs, which had developed to at least the 7-cell stage and had a cytoplasmic fragment rate of less than 20% [ 12 ]. Blastocysts were scored using the Gardner scoring system [ 13 ], which is based on blastocoel volume, the number of inner cell masses, the tightness of trophectoderm cell arrangement, and the density of trophoblast cell structure. On the D5, blastocysts were considered usable if they reached stage ≥ 3, with at least one of the inner cell mass and trophoblast grades being \"B\" or above; blastocysts with a score of ≥4BB were regarded as high-quality blastocysts. β-hCG positivity was defined as a blood β-hCG level > 5 U/L on day 7 after embryo transfer. Clinical pregnancy was confirmed by the presence of a gestational sac and fetal heart in the uterine cavity 4 to 5 weeks after embryo transfer. Live birth was defined as a normal pregnancy lasting 28 weeks or more, while miscarriage was defined as spontaneous abortion due to various reasons before 28 weeks of gestation. OHSS is characterized by multiple follicular development in both ovaries, ovarian enlargement, abnormal capillary permeability, fluid and protein extravasation into the third space, formation of pleural and peritoneal effusions, and a series of clinical manifestations including hemoconcentration, electrolyte disturbance, liver and kidney function impairment, and thrombosis. For the purpose of this study, the incidence of OHSS was restricted to patients who required hospitalization due to moderate to severe OHSS. 2.4 Outcome Indicators Baseline characteristics of the patients included age, body mass index (BMI), duration of infertility, type of infertility (primary or secondary), basal follicle-stimulating hormone (bFSH) level, basal estradiol (bE2) level, antral follicle count (AFC), anti-Müllerian hormone (AMH) level. Ovarian stimulation parameters included total Gn dosage, duration of Gn administration, number of oocytes retrieved, number of available embryos, number of high-quality embryos, incidence of moderate-to-severe OHSS requiring hospitalization, and rate of cycles with no transferable embryos. The observation indicators included the number of retrieved oocytes, number of high-quality embryos, number of blastocysts formation, incidence of OHSS, clinical pregnancy rate, miscarriage rate, preterm birth rate, live birth rate, cesarean section rate, and neonatal birth weight. Pregnancy outcomes included clinical pregnancy rate (confirmed by the presence of an intrauterine gestational sac on ultrasound 4–6 weeks after transfer), live birth rate (delivery of a viable neonate at ≥ 28 weeks of gestation), and miscarriage rate (pregnancy loss following clinical confirmation of pregnancy).Perinatal and neonatal outcomes included the preterm birth rate (delivery before 37 weeks of gestation), and neonatal birth weight. The calculation formulas of related rates were as follows: incidence of OHSS = (number of cycles with OHSS / number of transfer cycles) × 100%; clinical pregnancy rate = (number of clinical pregnancy cycles / number of transfer cycles) × 100%; miscarriage rate = (number of miscarriage cycles / number of clinical pregnancy cycles) × 100%; live birth rate = (number of live birth cycles / number of transfer cycles) × 100%. 2.5 Statistical Analysis Statistical analyses were performed using SPSS version 27.0 software. The Kolmogorov–Smirnov test was used to assess the normality of data distribution. Normally distributed data are presented as the mean ± standard deviation (x̄±s), while non-normally distributed data are presented as the median with interquartile range [P25, P75]. Between-group differences were analyzed using the independent-samples t-test for normally distributed data and the Mann–Whitney U test for non-normally distributed data. Categorical data are presented as percentages and compared using the χ² test. Multivariate logistic regression analysis was performed to evaluate the effects of ovarian stimulation protocols on clinical pregnancy outcomes. All tests were two-sided, and a P-value < 0.05 was considered statistically significant. 3. Results 3.1 Comparison of baseline data among the two groups of patients A total of 621 infertile patients with hyperlipidemia were finally enrolled in this study, including 195 patients in the follicular long-acting long protocol group and 426 patients in the antagonist protocol group. Baseline demographic and clinical characteristics of the two groups are summarized in Table 1 . Statistically significant intergroup differences were detected in age, proportion of primary infertility, and AFC (all P < 0.05). Specifically, patients in the antagonist protocol group were significantly older, had a lower proportion of primary infertility, and exhibited fewer antral follicles. No significant differences were found between the two groups in BMI, infertility duration, basal follicle-stimulating hormone (bFSH), basal estradiol (bE₂), anti-Müllerian hormone (AMH), as well as all baseline lipid metabolic indicators including total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) (all P > 0.05). Table 1 Comparison of Baseline Characteristics Between the Two Groups [(x̄±s), M(P25,P75), %] Indicator Follicular long-acting long protocol group (n = 195) Antagonist protocol group (n = 426) t/z/χ² P Age (years) 31.60 ± 4.88 33.14 ± 5.12 −2.032 0.043 BMI (kg/m²) 26.74 ± 4.63 26.03 ± 3.99 1.116 0.266 Infertility duration (years) 2.00(1.00,4.00) 3.00(2.00,5.00) −1.973 0.049 Primary infertility 58.46(114/195) 49.77(212/426) 4.057 0.044 bFSH /(U/L) 5.34(4.36,6.82) 5.79(4.71,6.82) −1.043 0.297 bE2/(pmol/L) 121.11(88.08,227.54) 117.44(83.71,194.51) −0.366 0.714 AFC (n) 18(14,24) 16(10,24) −2.027 0.043 AMH/(ng/ml) 2.32(1.55,3.60) 2.18(1.35,3.73) −0.625 0.532 TC (mmol/L) 5.08(4.23,5.51) 5.24(4.38,5.56) −0.715 0.475 TG (mmol/L) 1.68(0.99,1.97) 1.47(1.06,2.09) −0.068 0.946 LDL-C (mmol/L) 3.13(2.62,3.72) 3.29(2.77,3.65) −0.386 0.699 HDL-C (mmol/L) 1.2(1.00,1.42) 1.23(1.03,1.48) −1.815 0.069 3.2 Comparison of Ovarian Stimulation and Embryo Parameters The ovarian stimulation and embryonic related indicators of the two groups were further compared (Table 2 ).Statistically significant differences were observed between the follicular long-acting long protocol group and the antagonist protocol group in multiple key indicators. Specifically, the follicular long-acting long protocol group presented a higher total gonadotropin (Gn) dosage, longer duration of Gn administration, and a greater number of retrieved oocytes (all P < 0.05). Meanwhile, the long protocol group also achieved a significantly higher blastocyst formation rate, while the incidence of moderate-to-severe ovarian hyperstimulation syndrome (OHSS) was notably higher than that in the antagonist protocol group ( P = 0.045). In contrast, there were no significant intergroup differences in estradiol (E₂) and progesterone (P) levels on the day of hCG trigger, endometrial thickness, as well as the high-quality embryo rate (all P > 0.05). Table 2 Comparison of Ovarian Stimulation and Embryo Parameters Between the Two Groups [(x̄±s), n(%)] Indicator Follicular long-acting long protocol group (n = 195) Antagonist protocol group (n = 426) z/χ² P Total Gn dosage (U) 2975.00(2331.25,3337.50) 2625.00(2093.75,3271.88) −2.16 0.031 Gn usage days (days) 11.00(10.00,13.00) 10.00(9.00,11.00) −4.76 <0.001 hCG day E₂ (pmol/L) 2029.00(1346.50,3223.50) 1895.00(1030.75,2767.75) −1.59 0.113 hCG day P (nmol/L) 0.57(0.34,0.88) 0.60(0.37,0.82) −0.53 0.598 Endometrial thickness (mm) 11.82 ± 2.05 11.35 ± 2.04 2.42 0.121 Retrieved oocytes (n) 10.00(7.00,12.00) 8.00(5.00,12.00) −2.22 0.026 High-quality embryo rate (%) 45.07(645/1431) 44.32(1125/2538) 0.207 0.649 Blastocyst formation rate (%) 65.12%(672/1032) 59.67%(861/1443) 7.578 0.006 OHSS rate (%) 7.18(14/195) 3.52(15/426) 4.022 0.045 3.3 Comparison of fresh cycle transplantation and pregnancy outcomes between the two groups of patients There were no statistically significant differences between the two groups in the proportion of single embryo transfer (33.84% vs. 34.51%, P = 0.872), the rate of high-quality embryo transfer (80.00% vs. 74.65%, P = 0.145), and the proportion of blastocyst transfer (26.15% vs. 31.69%, P = 0.162). In terms of core pregnancy and perinatal outcomes, the two groups showed comparable clinical pregnancy rate (56.92% vs. 59.86%, P = 0.490), live birth rate (43.08% vs. 47.89%, P = 0.265), miscarriage rate (24.32% vs. 20.00%, P = 0.353), twin pregnancy rate (17.86% vs. 14.71%, P = 0.503), and cesarean section rate (57.14% vs. 48.53%, P = 0.184) (Table 3 ). Table 3 Comparison of fresh cycle transplantation and pregnancy outcomes between the two groups of patients[n(%)] Indicator Follicular long-acting long protocol group (n = 195) Antagonist protocol group (n = 426) χ² P value Transferred embryos (n = 1) 33.84(66/195) 34.51(147/426) 0.026 0.872 Transferred high-quality embryos 80.00(156/195) 74.65(318/426) 2.121 0.145 Blastocyst transfer (%) 26.15(51/195) 31.69(135/426) 1.954 0.162 Clinical pregnancy rate (%) 56.92(111/195) 59.86(255/426) 0.476 0.490 Live birth rate (%) 43.08(84/195) 47.89(204/426) 1.245 0.265 Miscarriage rate (%) 24.32(27/111) 20.00(51/255) 0.862 0.353 Twin rate (%) 17.86(15/84) 14.71(30/204) 0.448 0.503 Cesarean section rate (%) 57.14(48/84) 48.53(99/204) 1.767 0.184 3.4 Comparison of neonatal outcomes between the two groups of patients Neonatal and gestational outcomes of live births were further analyzed between the two groups (Table 4 ). There were 84 live neonates in the follicular long-acting long protocol group and 204 live neonates in the antagonist protocol group. No statistically significant differences were detected between the two groups in gestational age distribution, including rates of extremely preterm birth (< 34 weeks), moderate preterm birth (34–37 weeks) and full-term birth (≥ 37 weeks) (all P > 0.05). Additionally, the incidence of low birth weight, normal birth weight proportion, and macrosomia rate were also comparable between the two groups, with no significant inter-group differences observed (all P > 0.05). Table 4 Comparison of neonatal outcomes between the two groups of patients Indicator Follicular long-acting long protocol group (n = 84) Antagonist protocol group (n = 204) χ² P Gestational age <34 5.95(5/84) 4.41(9/204) 0.305 0.581 Gestational age 34–37 11.90(10/84) 14.71(30/204) 0.390 0.532 Gestational age ≥ 37 82.14(69/84) 80.88(165/204) 0.062 0.803 Proportion of low birth weight infants 14.29(12/84) 14.71(30/204) 0.008 0.927 Proportion of normal birth weight infants 78.57(66/84) 80.88(165/204) 0.200 0.655 Proportion of macrosomic infants 7.14(6/84) 4.41(9/204) 0.899 0.343 3.5 Multivariate Logistic Regression Analysis Multivariate logistic regression analysis was conducted to screen the independent influencing factors of clinical pregnancy rate. Covariates included age, BMI, infertility duration, infertility type, endometrial thickness, blood lipid indicators (TC, TG, LDL-C, HDL), high-quality embryo transfer status, and ovarian stimulation protocol. As shown in Table 5 , after adjusting for all confounding factors, only age was identified as an independent influencing factor for clinical pregnancy ( β = -0.061, aOR = 0.940, 95%CI = 0.885–1.000, P = 0.049). Specifically, advanced age was negatively correlated with the probability of clinical pregnancy, and the likelihood of clinical pregnancy decreased by approximately 6% per additional year of age. No statistically significant independent effects were found for other variables, including BMI, infertility duration, infertility type, endometrial thickness, all lipid metabolism markers, and high-quality embryo transfer (all P > 0.05). Critically, when taking the follicular long-acting long protocol as the reference group, the antagonist protocol showed no significant difference in the adjusted odds of clinical pregnancy ( aOR = 0.765, 95%CI = 0.407–1.437, P = 0.404). Table 5 Multivariate Logistic Regression Analysis of Factors Influencing Clinical Pregnancy Rate Variable β SE Wald aOR(95%CI) P Age -0.061 0.031 3.874 0.940(0.885-1.000) 0.049 BMI 0.000 0.039 0.000 1.000(0.926–1.080) 0.995 Infertility duration (years) 0.039 0.045 0.742 1.040(0.952–1.136) 0.389 Types of infertility 0.340 0.304 1.252 1.405(0.774–2.551) 0.263 Endometrial thickness -0.016 0.073 0.051 0.984(0.853–1.134) 0.822 TC 0.131 0.289 0.205 1.140(0.674–2.707) 0.397 TG -0.049 0.097 0.255 0.952(0.787–1.151) 0.613 LDL -0.328 0.364 0.813 0.720(0.353–1.470) 0.367 HDL -0.133 0.616 0.047 0.875(0.262–2.927) 0.829 Transferred high-quality embryos 0.301 0.355 0.718 1.351(0.674–2.707) 0.397 Follicular long-acting long protocol reference Antagonist protocol -0.268 0.322 0.696 0.765(0.407–1.437) 0.404 4. Discussion This study systematically compared the efficacy, safety, and neonatal outcomes of the follicular long-acting long protocol versus the antagonist protocol in infertile patients with hyperlipidemia, and further explored independent predictors of clinical pregnancy using multivariate regression analysis. Our results demonstrated that the long protocol required a higher total gonadotropin dosage, longer stimulation duration, more retrieved oocytes, and better blastocyst formation potential. However, this regimen was also associated with a significantly elevated risk of moderate-to-severe ovarian hyperstimulation syndrome (OHSS). In contrast, the antagonist protocol shortened the treatment cycle, reduced gonadotropin exposure, and provided a more favorable safety profile. Most importantly, after adjusting for baseline differences in embryo transfer, no significant differences were observed between the two groups in key fresh-cycle reproductive outcomes, including clinical pregnancy rate, live birth rate, miscarriage rate, obstetric complications, and long-term neonatal outcomes. Regression analysis confirmed that only advanced maternal age was an independent negative risk factor for clinical pregnancy, whereas ovarian stimulation protocol and baseline blood lipid levels exerted no independent effect on pregnancy outcomes. Previous studies have suggested that prolonged exposure of oocytes and endometrium to high concentrations of gonadotropin can lead to a decline in oocyte quality and endometrial receptivity [ 14 ]. Some researchers have also reported that ovarian stimulation exceeding 13 days is associated with reduced clinical pregnancy and live birth rates in fresh cycles [ 15 ]. In the present study, compared with the long GnRH agonist protocol, the GnRH antagonist protocol significantly shortened the duration of ovarian stimulation [11.00 (10.00, 13.00) vs. 10.00 (9.00, 11.00), P < 0.001] and reduced total gonadotropin consumption [2975.00 (2331.25, 3337.50) vs. 2625.00 (2093.75, 3271.88), P = 0.031]. Although the number of retrieved oocytes and blastocyst formation rate were higher in the agonist group, the blastocyst transfer rate showed an increasing trend in the antagonist group (26.15% vs. 31.69%), which might be attributed to the shorter stimulation duration and milder endocrine environment in antagonist cycles. Although the antagonist protocol is widely recommended for patients at high risk of OHSS due to its favorable safety profile in reducing moderate-to-severe OHSS, some studies have suggested that the follicular long-acting long protocol may provide higher clinical pregnancy, implantation, and live birth rates in patients with normal ovarian response, and has been widely accepted by reproductive physicians worldwide. This discrepancy might be partially explained by the relatively unstable LH surge and impaired endometrial receptivity associated with antagonist protocols [ 16 , 17 ]. Furthermore, the expression level of HOXA10, a key regulator of endometrial proliferation, differentiation, and embryo implantation, was significantly lower in antagonist cycles than in the follicular long-acting long protocol cycles [ 18 ]. In addition, a study reported that endometrial AIF-1 expression was upregulated in antagonist cycles compared with the follicular long-acting long protocol, which may adversely affect embryo implantation by mediating TNF-α signaling [ 19 ]. However, all these studies were conducted mainly in normolipidemic populations rather than infertile patients with hyperlipidemia. The results of this study demonstrated that, compared with the long GnRH agonist protocol group, infertile patients with dyslipidemia who underwent ovulation induction using the GnRH antagonist protocol exhibited an upward trend in both clinical pregnancy rate (56.92% vs. 59.86%) and live birth rate (43.08% vs. 47.89%), although these differences did not reach statistical significance. This favorable trend might be attributed to the shorter duration of ovarian stimulation and the relatively higher proportion of blastocyst transfer in the antagonist protocol group, which may have counteracted the potential adverse effects of the antagonist regimen on endometrial receptivity. Previous studies have shown that dyslipidemia is closely associated with oocyte and embryo quality. Wang et al. [ 20 ] found that serum levels of TG, TC, and LDL were negatively correlated with embryo quality, while HDL levels were positively correlated with embryo quality. Liu et al. demonstrated that dyslipidemia was independently associated with a lower cumulative live birth rate in non-PCOS patients undergoing IVF/ICSI [ 21 ]. Jiang et al. found that elevated total cholesterol negatively impacts cumulative live birth rate in PCOS patients after the first ovarian stimulation cycle [ 22 ]. Yang et al. [ 23 ] reported that hyperlipidemia may increase the required gonadotropin dosage and exert adverse effects on embryo quality and endometrial receptivity during IVF in non-obese patients with polycystic ovary syndrome, thereby increasing the miscarriage rate. In the present study, the miscarriage rates in both groups were relatively high (24.32% and 20.00%, respectively), which was consistent with the above findings. Multivariate logistic regression further confirmed that ovarian stimulation protocol was not an independent influencing factor for clinical pregnancy, whereas advanced age was the only independent risk factor; these results indicate that in patients with hyperlipidemia, the potential adverse effects of antagonist protocols on endometrial receptivity may be offset by metabolic and endocrine factors specific to this population, thereby achieving comparable reproductive outcomes with a safer stimulation profile. The major innovation of this study lies in its targeted focus on the special population of infertile patients with hyperlipidemia, rather than the general IVF population, which fills an existing evidence gap in protocol selection guidance for this patient subgroup. Our findings carry important clinical implications: for infertile women with hyperlipidemia, clinicians do not have to compromise overall pregnancy chances when choosing the antagonist protocol, as its shorter treatment course, lower drug consumption, and substantially reduced OHSS risk allow it to be safely and preferentially recommended—especially for patients with high OHSS susceptibility—without sacrificing ultimate reproductive efficiency or neonatal safety. Meanwhile, this study suggests that for patients with mild to moderate hyperlipidemia, routine individualized controlled ovarian stimulation can effectively offset the potential negative impact of dyslipidemia on treatment outcomes, and age remains the most critical prognostic indicator for clinical pregnancy, highlighting the need to emphasize timely fertility awareness and intervention during reproductive counseling. Notably, this study has several limitations. First, it was a single-center retrospective analysis prone to selection bias, the relatively large sample size may still limit generalizability to diverse populations. Second, long-term neonatal outcomes were not followed up, including long-term physical growth and metabolic health status in childhood. Third, the molecular mechanisms underlying protocol-specific effects (e.g., oxidative stress markers or lipid metabolites in follicular fluid) remain unexplored. Thus, future large-scale multicenter prospective studies are required to validate these findings and further investigate the long-term safety and efficacy of different stimulation protocols in hyperlipidemic infertile patients. 5. Conclusions In conclusion, the follicular long-acting long GnRH agonist protocol and the GnRH antagonist protocol achieve comparable clinical pregnancy and live birth rates in infertile patients with hyperlipidemia. The antagonist protocol is associated with shorter stimulation duration, lower gonadotropin consumption, and a lower risk of moderate-to-severe OHSS, supporting its preferential use in this population. Multivariate analysis confirmed that advanced age is the only independent negative predictor of clinical pregnancy, whereas ovarian stimulation protocol and baseline lipid levels have no independent effect. Routine lipid screening and individualized ovarian stimulation strategies should be emphasized to optimize reproductive outcomes in hyperlipidemic patients undergoing IVF/ICSI. Abbreviations ART assisted reproductive technology BMI body mass index E₂ estradiol FET frozen-thawed embryo transfer Gn gonadotropin GnRH-a gonadotropin-releasing hormone agonist hCG human chorionic gonadotropin HDL-C high-density lipoprotein cholesterol ICSI intracytoplasmic sperm injection IVF in vitro fertilization LDL-C low-density lipoprotein cholesterol OHSS ovarian hyperstimulation syndrome P progesterone PCOS polycystic ovary syndrome PGD preimplantation genetic diagnosis PGS preimplantation genetic screening TC total cholesterol TG triglycerides Declarations Ethics approval and consent to participate This study was approved by the Ethics Committee of the Fourth Hospital of Shijiazhuang (approval number: 20240022). The study was performed in accordance with the Declaration of Helsinki. Waiver of informed consent was approved due to the retrospective nature without identifiable patient information. Consent for publication Not applicable Competing Interests The authors declare that they have no competing interests. Funding This work was supported by grants from Medical Science Research Project of Hebei (No.20251111). Author Contribution X.-H.Z. and G.S. contributed equally to this work. X.-H.Z. and G.S. designed the study, analyzed the data, and wrote the main manuscript. X.-L.Z., Y.-J.D., and Y.-N.C. collected the clinical data. Y.J. and C.-P.G. supervised the project and revised the manuscript critically. All authors have read and approved the final manuscript. Acknowledgements We thank all the staff in the center for reproductive medicine of the Center for Reproductive Medicine of the Fourth Hospital of Shijiazhuang. Data Availability The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. References Chen J, Fu D, Ma T, Chen M, Wang X, Yi J. Global burden of metabolic disorders among women of child-bearing age, 1990–2021: a population-based study1990-2021, BMC Womens Health. 2025;25(1):207. Yang F, Lu JC, Shen T, Jin YH, Liang YJ. Effect of hyperlipidemia on the outcome of in vitro fertilization in non-obese patients with polycystic ovary syndrome. Front Endocrinol (Lausanne). 2023;14:1281794. Cai WY, Luo X, Chen E, Lv H, Fu K, Wu XK, et al. Serum Lipid Levels and Treatment Outcomes in Women Undergoing Assisted Reproduction: A Retrospective Cohort Study. Front Endocrinol (Lausanne). 2021;12:633766. Meulders B, Marei WFA, Loier L, Leroy JLMR. Lipotoxicity and Oocyte Quality in Mammals: Pathogenesis, Consequences, and Reversibility. Annu Rev Anim Biosci. 2025;13(1):233–254. Lambalk CB, Banga FR, Huirne JA, Toftager M, Pinborg A, Homburg R, et al. GnRH antagonist versus long agonist protocols in IVF: a systematic review and meta-analysis accounting for patient type. Hum Reprod Update. 2017;23(5):560–579. Yang R, Guan Y, Perrot V, Ma J, Li R. Comparison of the Long-Acting GnRH Agonist Follicular Protocol with the GnRH Antagonist Protocol in Women Undergoing In Vitro Fertilization: A Systematic Review and Meta-analysis. Adv Ther. 2021;38(5):2027–2037. Al-Inany HG, Youssef MA, Ayeleke RO, Brown J, Lam WS, Broekmans FJ. Gonadotrophin-releasing hormone antagonists for assisted reproductive technology. Cochrane Database Syst Rev. 2016;4(4):CD001750. Yang J, Zhang X, Ding X, Wang Y, Huang G, Ye H. Cumulative live birth rates between GnRH-agonist long and GnRH-antagonist protocol in one ART cycle when all embryos transferred: real-word data of 18,853 women from China. Reprod Biol Endocrinol. 2021;19(1):124. Wu L, Ren XL, Chen W, Huang B, Zhou YF, Jin L. Influence of Different Gonadotropin-releasing Hormone Agonist Administration Methods on Pregnancy Outcomes of Patients Undergoing In-vitro Fertilization-embryo Transfer. Curr Med Sci. 2019;39(3):437–441. Zheng D, Wang Y, Chen L, Zeng L, Li R. Association between body mass index and in vitro fertilization/intra-cytoplasmic sperm injection outcomes: An analysis of 15,124 normal ovarian responders in China. Chin Med J (Engl). 2024;137(7):837–845. Joint committee for guideline revision. 2016 Chinese guidelines for the management of dyslipidemia in adults. J Geriatr Cardiol. 2018;15(1):1–29. Alpha Scientists in Reproductive Medicine and ESHRE Special Interest Group of Embryology. The Istanbul consensus workshop on embryo assessment: proceedings of an expert meeting. Hum Reprod. 2011;26(6):1270-83. Gardner DK, Lane M, Stevens J, Schlenker T, Schoolcraft WB. Blas-tocyst score affects implantation and pregnancy outcome: Towards a single blastocyst transfer. Fertil Steril 2000;73:1155–1158. Kaleli S, Yanikkaya-Demirel G, Erel CT, Senturk LM, Topçuoğlu A, Irez T. High rate of aneuploidy in luteinized granulosa cells obtained from follicular fluid in women who underwent controlled ovarian hyperstimulation. Fertil Steril. 2005;84(3):802–4. Pereira N, Friedman C, Hutchinson AP, Lekovich JP, Elias RT, Rosenwaks Z. Increased odds of live birth in fresh in vitro fertilization cycles with shorter ovarian stimulation. Fertil Steril. 2017;107(1):104–109.e2. Lambalk CB, Banga FR, Huirne JA, Toftager M, Pinborg A, Homburg R,et al. GnRH antagonist versus long agonist protocols in IVF: a systematic review and meta-analysis accounting for patient type. Hum Reprod Update. 2017;23(5):560–579. Yang R, Guan Y, Perrot V, Ma J, Li R. Comparison of the Long-Acting GnRH Agonist Follicular Protocol with the GnRH Antagonist Protocol in Women Undergoing In Vitro Fertilization: A Systematic Review and Meta-analysis. Adv Ther. 2021;38(5):2027–2037. Wang Y, Hu S, Yao G, Sun Y. Identification of HOXA10 target genes in human endometrial stromal cells by RNA-seq analysis. Acta Biochim Biophys Sin (Shanghai). 2021;53(3):365–371. Xu B, Zhou M, Wang J, Zhang D, Guo F, Si C, et al. Increased AIF-1-mediated TNF-α expression during implantation phase in IVF cycles with GnRH antagonist protocol. Hum Reprod. 2018;33(7):1270–1280. Wang S, Wang J, Jiang Y, Jiang W. Association between blood lipid level and embryo quality during in vitro fertilization. Medicine (Baltimore). 2020;99(13):e19665. Liu Z, Cong J, Liu X, Zhao H, Lai S, He S, et al. Dyslipidemia Is Negatively Associated With the Cumulative Live-Birth Rate in Patients Without PCOS Following IVF/ICSI. Front Physiol. 2021;12:713356. Jiang X, Lu X, Cai M, Liu Y, Guo Y. Impact of dyslipidemia on the cumulative pregnancy outcomes after first ovarian stimulation. Front Endocrinol (Lausanne). 2022;13:915424. Yang F, Lu JC, Shen T, Jin YH, Liang YJ. Effect of hyperlipidemia on the outcome of in vitro fertilization in non-obese patients with polycystic ovary syndrome. Front Endocrinol (Lausanne). 2023;14:1281794. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 12 May, 2026 Reviewers invited by journal 06 May, 2026 Editor assigned by journal 30 Apr, 2026 Submission checks completed at journal 29 Apr, 2026 First submitted to journal 28 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-9481660\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":false,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":639095719,\"identity\":\"10d89c90-0fba-481d-a637-8198bf9f6127\",\"order_by\":0,\"name\":\"Xuhui Zhang\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"The Fourth Hospital of Shijiazhuang\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Xuhui\",\"middleName\":\"\",\"lastName\":\"Zhang\",\"suffix\":\"\"},{\"id\":639095720,\"identity\":\"26cb9c80-2c44-4f0c-a989-33351f036a1c\",\"order_by\":1,\"name\":\"Ge Song\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"The Fourth Hospital of Shijiazhuang\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Ge\",\"middleName\":\"\",\"lastName\":\"Song\",\"suffix\":\"\"},{\"id\":639095721,\"identity\":\"bfc264d6-29dd-41f0-b750-6620e91c454f\",\"order_by\":2,\"name\":\"Xiaoling Zhang\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"The Fourth Hospital of Shijiazhuang\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Xiaoling\",\"middleName\":\"\",\"lastName\":\"Zhang\",\"suffix\":\"\"},{\"id\":639095722,\"identity\":\"3de3caeb-3420-4f02-8e56-6e2d8c080de5\",\"order_by\":3,\"name\":\"Yinjing Dong\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"The Fourth Hospital of Shijiazhuang\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Yinjing\",\"middleName\":\"\",\"lastName\":\"Dong\",\"suffix\":\"\"},{\"id\":639095723,\"identity\":\"c54dbfe4-878d-4984-9ab6-9794a906ab77\",\"order_by\":4,\"name\":\"Yaonan Cao\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"The Fourth Hospital of Shijiazhuang\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Yaonan\",\"middleName\":\"\",\"lastName\":\"Cao\",\"suffix\":\"\"},{\"id\":639095724,\"identity\":\"c7ed6395-673e-4020-a987-d36f235a1291\",\"order_by\":5,\"name\":\"Yan Jiang\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4klEQVRIie3QIQvCQBTA8TsOLp2uvqHoV3hDEJtf5QZiUlhcEN2YbEHFuuZXMBoHg6WzGydWgzaDQc2KN5vhfly8P+/uEWIYf4hbUV5eEGZhsr6W0p/okzoUQyf1ejRaZh0sVaFPWmSEDXHxaZLKrn2cswoPIwpRILBaIIe+G3BiJQv5PWGxVwICt4OsOLi7JgG132qm5FtEBOGEYXxwFScIY10iEZ4H+jnjnhuzKskAIUNAGnNOqiWvJQfPQXQpGEhVCO1f2usoP93vU0k3Z3q9+ZOWlay+J2/Eb9cNwzCMjx5VBElJLGxBcQAAAABJRU5ErkJggg==\",\"orcid\":\"\",\"institution\":\"The Fourth Hospital of Shijiazhuang\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Yan\",\"middleName\":\"\",\"lastName\":\"Jiang\",\"suffix\":\"\"},{\"id\":639095725,\"identity\":\"97d27ab0-7ac2-4e25-9e07-0d1f3e095a53\",\"order_by\":6,\"name\":\"Caiping Geng\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"The Fourth Hospital of Shijiazhuang\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Caiping\",\"middleName\":\"\",\"lastName\":\"Geng\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2026-04-21 09:08:30\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-9481660/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-9481660/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":109405400,\"identity\":\"06819811-42a3-4add-8e69-bbc7892c4342\",\"added_by\":\"auto\",\"created_at\":\"2026-05-17 13:17:49\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":306725,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-9481660/v1/34b17fa7-2269-46ed-90da-5e31651cad12.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Comparison of the Follicular Long-Acting Long Protocol and Antagonist Protocol in Infertile Patients with Hyperlipidemia\",\"fulltext\":[{\"header\":\"1. Introduction\",\"content\":\"\\u003cp\\u003eIn recent decades, the global prevalence of hyperlipidemia has been increasing, particularly among women of childbearing age [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e]. Accumulating evidence suggests that hyperlipidemia is closely associated with adverse outcomes in assisted reproductive technology (ART), including impaired ovarian response, compromised oocyte quality, poor endometrial receptivity, and reduced live birth rates [\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e]. Hyperlipidemia triggers oxidative stress and chronic inflammatory reactions in the reproductive system, thereby interfering with follicular development and embryo implantation [\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e]. For infertile patients with hyperlipidemia, choosing an appropriate ovarian stimulation protocol is critical to improving therapeutic efficacy and safety.\\u003c/p\\u003e \\u003cp\\u003eThe follicular-phase long-acting long protocol and the antagonist protocol are the two most commonly used ovarian stimulation regimens in clinical ART [\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e]. The follicular-phase long-acting long protocol achieves synchronized follicular growth via gonadotropin-releasing hormone agonist (GnRH-a) downregulation, yielding consistent oocyte retrieval but requiring a prolonged treatment duration and high gonadotropin (Gn) dosage [\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e]. In contrast, the antagonist protocol starts ovarian stimulation directly and uses GnRH antagonists to prevent premature luteinizing hormone (LH) surges in the mid-follicular phase, with the benefits of a short cycle, favorable safety profile, and low risk of ovarian hyperstimulation syndrome (OHSS) [\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e]. Previous studies comparing ovarian stimulation protocols have mainly focused on normolipidemic individuals, with scarce data available for patients with hyperlipidemia [\\u003cspan additionalcitationids=\\\"CR9\\\" citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e]. Therefore, the optimal ovarian stimulation strategy for infertile patients with hyperlipidemia has not been established. Metabolic disorders caused by hyperlipidemia may interact differently with distinct stimulation regimens and further affect treatment outcomes. This study retrospectively compared the efficacy and pregnancy outcomes between the follicular-phase long-acting long protocol and the antagonist protocol in infertile patients with hyperlipidemia, aiming to provide evidence for individualized protocol selection in clinical practice.\\u003c/p\\u003e\"},{\"header\":\"2. Materials and Methods\",\"content\":\"\\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e2.1 Study participants\\u003c/h2\\u003e \\u003cp\\u003eA total of 621 infertile patients with hyperlipidemia who received in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatment at the Reproductive Medicine Center of our hospital from January 2021 to December 2023 were enrolled in this study. The diagnostic criteria for hyperlipidemia were based on the 2016 Guidelines for the Prevention and Treatment of Hyperlipidemia in Chinese Adults [\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e]. Hyperlipidemia was defined as the presence of at least one of the following indicators: total cholesterol (TC)\\u0026thinsp;\\u0026ge;\\u0026thinsp;5.18 mmol/L, low-density lipoprotein cholesterol (LDL-C)\\u0026thinsp;\\u0026ge;\\u0026thinsp;3.37 mmol/L, high-density lipoprotein cholesterol (HDL-C)\\u0026thinsp;\\u0026lt;\\u0026thinsp;1.04 mmol/L, and triglycerides (TG)\\u0026thinsp;\\u0026ge;\\u0026thinsp;1.7 mmol/L. Inclusion criteria were as follows: (1) Age\\u0026thinsp;\\u0026le;\\u0026thinsp;43 years; (2) Diagnosed with primary or secondary infertility; (3) Underwent ovarian stimulation using either the follicular-phase long-acting long protocol or the antagonist protocol; (4) Underwent the first fresh cycle embryo or blastocyst transfer; (5) Complete clinical data and clear follow-up of pregnancy outcomes. Exclusion criteria were as follows: (1) Severe hepatic or renal insufficiency, uncontrolled thyroid dysfunction, diabetes mellitus, or hypertension; (2) Premature ovarian insufficiency, endometriosis, uterine malformation, or moderate-to-severe intrauterine adhesions; (3) Donor oocyte cycles or preimplantation genetic diagnosis/screening (PGD/PGS) cycles; (4) Use of lipid-lowering drugs, hormonal agents, or antioxidants within 3 months prior to treatment; (5) Chromosomal abnormalities in either partner; (6) Endometrial thickness\\u0026thinsp;\\u0026lt;\\u0026thinsp;8 mm on the day of human chorionic gonadotropin (hCG) administration. This study was approved by the Ethics Committee of the Fourth Hospital of Shijiazhuang (Ethics Number: 20240022), and all procedures were performed in accordance with the relevant ethical guidelines.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec4\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e2.2 Grouping Methods\\u003c/h2\\u003e \\u003cp\\u003ePatients were divided into two groups based on the ovarian stimulation protocol: Follicular long-acting long protocol group (n\\u0026thinsp;=\\u0026thinsp;195): On days 20\\u0026ndash;22 of the menstrual cycle, patients received GnRH-a (Triptorelin, Ipsen France) for downregulation. Ovarian stimulation was initiated with recombinant human FSH (rFSH, Gonal-f, Merck Serono Switzerland) or human menopausal gonadotropin (HMG, Livzon Group China) 14 days later, after confirming successful downregulation (LH\\u0026thinsp;\\u0026lt;\\u0026thinsp;5 U/L, E₂ \\u0026lt;50 pg/mL, follicle diameter\\u0026thinsp;\\u0026lt;\\u0026thinsp;5 mm).Antagonist protocol group (n\\u0026thinsp;=\\u0026thinsp;426): Ovarian stimulation was initiated with rFSH or HMG on day 3 of the menstrual cycle. GnRH antagonist (Cetrorelix, Merck Germany) was added when the leading follicle diameter reached\\u0026thinsp;\\u0026ge;\\u0026thinsp;12 mm to suppress the LH surge.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec5\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e2.3 Ovarian Stimulation and ART Procedures\\u003c/h2\\u003e \\u003cp\\u003eOvulation induction and oocyte retrieval: All patients were treated with long-acting ovulation induction protocols or antagonist protocols during the follicular phase. After 8 to 14 days of ovulation induction, when at least 2 follicles were \\u0026ge;\\u0026thinsp;18mm in diameter, or 3 follicles were \\u0026ge;\\u0026thinsp;17mm in diameter, 5000 to 10000 U of chorionic gonadotropin (HCG, Zhuhai Livzon, China) or 250 \\u0026micro;g of recombinant HCG (Ovitrelle; Merck, Switzerland) was injected intramuscularly to trigger ovulation. 36 to 38 hours after triggering, oocytes were retrieved under vaginal ultrasound guidance and fertilization was performed via conventional IVF or ICSI based on semen quality. All patients underwent fresh cycle transplantation, and 1 to 2 cleavage-stage embryos on the third day (D3) or 1 blastocyst-stage embryos on the fifth day (D5) of the cycle were transplanted according to the patient's age, medical history, and embryo development in this cycle.\\u003c/p\\u003e \\u003cp\\u003eLuteal support: From the day of oocyte retrieval, all patients were given vaginal sustained-release gel of progesterone (Crinone; Merck Serono, Germany) 90 mg per dose, administered once daily, or soft capsules of progesterone (Utrogestan; Besins Healthcare, France) 0.2 g per dose, administered three times daily. After embryo transplantation, diethylprogesterone tablets (Duphaston; Solvay, the Netherlands) 10 mg per dose were orally administered three times daily. Seven days later, if the blood β-HCG level was \\u0026gt;\\u0026thinsp;5 U/L, it was considered HCG positive, and luteal support was continued until 60 days after transplantation, with the dosage gradually reduced before discontinuing the medication.\\u003c/p\\u003e \\u003cp\\u003eEmbryo assessment criteria and pregnancy determination: On the D3, the development and quality of the embryos were evaluated based on the number of cleavage cells, the size of the cleavage cells, and the percentage of fragments. High-quality D3 embryos were defined as those derived from normal fertilization of 2-pronuclear (2PN) fertilized eggs, which had developed to at least the 7-cell stage and had a cytoplasmic fragment rate of less than 20% [\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e]. Blastocysts were scored using the Gardner scoring system [\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e], which is based on blastocoel volume, the number of inner cell masses, the tightness of trophectoderm cell arrangement, and the density of trophoblast cell structure. On the D5, blastocysts were considered usable if they reached stage\\u0026thinsp;\\u0026ge;\\u0026thinsp;3, with at least one of the inner cell mass and trophoblast grades being \\\"B\\\" or above; blastocysts with a score of \\u0026ge;4BB were regarded as high-quality blastocysts. β-hCG positivity was defined as a blood β-hCG level\\u0026thinsp;\\u0026gt;\\u0026thinsp;5 U/L on day 7 after embryo transfer. Clinical pregnancy was confirmed by the presence of a gestational sac and fetal heart in the uterine cavity 4 to 5 weeks after embryo transfer. Live birth was defined as a normal pregnancy lasting 28 weeks or more, while miscarriage was defined as spontaneous abortion due to various reasons before 28 weeks of gestation.\\u003c/p\\u003e \\u003cp\\u003eOHSS is characterized by multiple follicular development in both ovaries, ovarian enlargement, abnormal capillary permeability, fluid and protein extravasation into the third space, formation of pleural and peritoneal effusions, and a series of clinical manifestations including hemoconcentration, electrolyte disturbance, liver and kidney function impairment, and thrombosis. For the purpose of this study, the incidence of OHSS was restricted to patients who required hospitalization due to moderate to severe OHSS.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec6\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e2.4 Outcome Indicators\\u003c/h2\\u003e \\u003cp\\u003eBaseline characteristics of the patients included age, body mass index (BMI), duration of infertility, type of infertility (primary or secondary), basal follicle-stimulating hormone (bFSH) level, basal estradiol (bE2) level, antral follicle count (AFC), anti-M\\u0026uuml;llerian hormone (AMH) level.\\u003c/p\\u003e \\u003cp\\u003eOvarian stimulation parameters included total Gn dosage, duration of Gn administration, number of oocytes retrieved, number of available embryos, number of high-quality embryos, incidence of moderate-to-severe OHSS requiring hospitalization, and rate of cycles with no transferable embryos.\\u003c/p\\u003e \\u003cp\\u003eThe observation indicators included the number of retrieved oocytes, number of high-quality embryos, number of blastocysts formation, incidence of OHSS, clinical pregnancy rate, miscarriage rate, preterm birth rate, live birth rate, cesarean section rate, and neonatal birth weight. Pregnancy outcomes included clinical pregnancy rate (confirmed by the presence of an intrauterine gestational sac on ultrasound 4\\u0026ndash;6 weeks after transfer), live birth rate (delivery of a viable neonate at \\u0026ge;\\u0026thinsp;28 weeks of gestation), and miscarriage rate (pregnancy loss following clinical confirmation of pregnancy).Perinatal and neonatal outcomes included the preterm birth rate (delivery before 37 weeks of gestation), and neonatal birth weight. The calculation formulas of related rates were as follows: incidence of OHSS = (number of cycles with OHSS / number of transfer cycles) \\u0026times; 100%; clinical pregnancy rate = (number of clinical pregnancy cycles / number of transfer cycles) \\u0026times; 100%; miscarriage rate = (number of miscarriage cycles / number of clinical pregnancy cycles) \\u0026times; 100%; live birth rate = (number of live birth cycles / number of transfer cycles) \\u0026times; 100%.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec7\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e2.5 Statistical Analysis\\u003c/h2\\u003e \\u003cp\\u003eStatistical analyses were performed using SPSS version 27.0 software. The Kolmogorov\\u0026ndash;Smirnov test was used to assess the normality of data distribution. Normally distributed data are presented as the mean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;standard deviation (x̄\\u0026plusmn;s), while non-normally distributed data are presented as the median with interquartile range [P25, P75]. Between-group differences were analyzed using the independent-samples t-test for normally distributed data and the Mann\\u0026ndash;Whitney U test for non-normally distributed data. Categorical data are presented as percentages and compared using the χ\\u0026sup2; test. Multivariate logistic regression analysis was performed to evaluate the effects of ovarian stimulation protocols on clinical pregnancy outcomes. All tests were two-sided, and a P-value\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05 was considered statistically significant.\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"3. Results\",\"content\":\"\\u003cdiv id=\\\"Sec9\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e3.1 Comparison of baseline data among the two groups of patients\\u003c/h2\\u003e \\u003cp\\u003eA total of 621 infertile patients with hyperlipidemia were finally enrolled in this study, including 195 patients in the follicular long-acting long protocol group and 426 patients in the antagonist protocol group. Baseline demographic and clinical characteristics of the two groups are summarized in Table\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e. Statistically significant intergroup differences were detected in age, proportion of primary infertility, and AFC (all \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05). Specifically, patients in the antagonist protocol group were significantly older, had a lower proportion of primary infertility, and exhibited fewer antral follicles. No significant differences were found between the two groups in BMI, infertility duration, basal follicle-stimulating hormone (bFSH), basal estradiol (bE₂), anti-M\\u0026uuml;llerian hormone (AMH), as well as all baseline lipid metabolic indicators including total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) (all P\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05).\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eComparison of Baseline Characteristics Between the Two Groups [(x̄\\u0026plusmn;s), M(P25,P75), %]\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"5\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eIndicator\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eFollicular long-acting long protocol group (n\\u0026thinsp;=\\u0026thinsp;195)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eAntagonist protocol group (n\\u0026thinsp;=\\u0026thinsp;426)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003et/z/χ\\u0026sup2;\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eP\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAge (years)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e31.60\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;4.88\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e33.14\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;5.12\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e\\u0026minus;2.032\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.043\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBMI (kg/m\\u0026sup2;)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e26.74\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;4.63\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e26.03\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;3.99\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1.116\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.266\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eInfertility duration (years)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2.00(1.00,4.00)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e3.00(2.00,5.00)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e\\u0026minus;1.973\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.049\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePrimary infertility\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e58.46(114/195)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e49.77(212/426)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e4.057\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.044\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ebFSH /(U/L)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e5.34(4.36,6.82)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e5.79(4.71,6.82)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e\\u0026minus;1.043\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.297\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ebE2/(pmol/L)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e121.11(88.08,227.54)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e117.44(83.71,194.51)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e\\u0026minus;0.366\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.714\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAFC (n)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e18(14,24)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e16(10,24)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e\\u0026minus;2.027\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.043\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAMH/(ng/ml)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2.32(1.55,3.60)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2.18(1.35,3.73)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e\\u0026minus;0.625\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.532\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eTC (mmol/L)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e5.08(4.23,5.51)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e5.24(4.38,5.56)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e\\u0026minus;0.715\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.475\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eTG (mmol/L)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1.68(0.99,1.97)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1.47(1.06,2.09)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e\\u0026minus;0.068\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.946\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eLDL-C (mmol/L)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e3.13(2.62,3.72)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e3.29(2.77,3.65)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e\\u0026minus;0.386\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.699\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eHDL-C (mmol/L)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1.2(1.00,1.42)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1.23(1.03,1.48)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e\\u0026minus;1.815\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.069\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec10\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e3.2 Comparison of Ovarian Stimulation and Embryo Parameters\\u003c/h2\\u003e \\u003cp\\u003eThe ovarian stimulation and embryonic related indicators of the two groups were further compared (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e).Statistically significant differences were observed between the follicular long-acting long protocol group and the antagonist protocol group in multiple key indicators. Specifically, the follicular long-acting long protocol group presented a higher total gonadotropin (Gn) dosage, longer duration of Gn administration, and a greater number of retrieved oocytes (all \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05). Meanwhile, the long protocol group also achieved a significantly higher blastocyst formation rate, while the incidence of moderate-to-severe ovarian hyperstimulation syndrome (OHSS) was notably higher than that in the antagonist protocol group (\\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.045). In contrast, there were no significant intergroup differences in estradiol (E₂) and progesterone (P) levels on the day of hCG trigger, endometrial thickness, as well as the high-quality embryo rate (all P\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05).\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eComparison of Ovarian Stimulation and Embryo Parameters Between the Two Groups [(x̄\\u0026plusmn;s), n(%)]\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"5\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eIndicator\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eFollicular long-acting long protocol group (n\\u0026thinsp;=\\u0026thinsp;195)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eAntagonist protocol group (n\\u0026thinsp;=\\u0026thinsp;426)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003ez/χ\\u0026sup2;\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eP\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eTotal Gn dosage (U)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2975.00(2331.25,3337.50)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2625.00(2093.75,3271.88)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e\\u0026minus;2.16\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.031\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eGn usage days (days)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e11.00(10.00,13.00)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e10.00(9.00,11.00)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e\\u0026minus;4.76\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ehCG day E₂ (pmol/L)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2029.00(1346.50,3223.50)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1895.00(1030.75,2767.75)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e\\u0026minus;1.59\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.113\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ehCG day P (nmol/L)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e0.57(0.34,0.88)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.60(0.37,0.82)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e\\u0026minus;0.53\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.598\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eEndometrial thickness (mm)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e11.82\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.05\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e11.35\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.04\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e2.42\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.121\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eRetrieved oocytes (n)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e10.00(7.00,12.00)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e8.00(5.00,12.00)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e\\u0026minus;2.22\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.026\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eHigh-quality embryo rate (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e45.07(645/1431)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e44.32(1125/2538)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.207\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.649\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBlastocyst formation rate (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e65.12%(672/1032)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e59.67%(861/1443)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e7.578\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.006\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eOHSS rate (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e7.18(14/195)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e3.52(15/426)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e4.022\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.045\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec11\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e3.3 Comparison of fresh cycle transplantation and pregnancy outcomes between the two groups of patients\\u003c/h2\\u003e \\u003cp\\u003eThere were no statistically significant differences between the two groups in the proportion of single embryo transfer (33.84% vs. 34.51%, \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.872), the rate of high-quality embryo transfer (80.00% vs. 74.65%, \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.145), and the proportion of blastocyst transfer (26.15% vs. 31.69%, \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.162). In terms of core pregnancy and perinatal outcomes, the two groups showed comparable clinical pregnancy rate (56.92% vs. 59.86%, \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.490), live birth rate (43.08% vs. 47.89%, \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.265), miscarriage rate (24.32% vs. 20.00%, \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.353), twin pregnancy rate (17.86% vs. 14.71%, \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.503), and cesarean section rate (57.14% vs. 48.53%, \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.184) (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab3\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab3\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 3\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eComparison of fresh cycle transplantation and pregnancy outcomes between the two groups of patients[n(%)]\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"5\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eIndicator\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eFollicular long-acting long protocol group (n\\u0026thinsp;=\\u0026thinsp;195)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eAntagonist protocol group (n\\u0026thinsp;=\\u0026thinsp;426)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eχ\\u0026sup2;\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eP value\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eTransferred embryos (n\\u0026thinsp;=\\u0026thinsp;1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e33.84(66/195)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e34.51(147/426)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.026\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.872\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eTransferred high-quality embryos\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e80.00(156/195)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e74.65(318/426)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e2.121\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.145\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBlastocyst transfer (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e26.15(51/195)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e31.69(135/426)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1.954\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.162\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eClinical pregnancy rate (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e56.92(111/195)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e59.86(255/426)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.476\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.490\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eLive birth rate (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e43.08(84/195)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e47.89(204/426)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1.245\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.265\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMiscarriage rate (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e24.32(27/111)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e20.00(51/255)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.862\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.353\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eTwin rate (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e17.86(15/84)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e14.71(30/204)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.448\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.503\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eCesarean section rate (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e57.14(48/84)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e48.53(99/204)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1.767\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.184\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec12\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e3.4 Comparison of neonatal outcomes between the two groups of patients\\u003c/h2\\u003e \\u003cp\\u003eNeonatal and gestational outcomes of live births were further analyzed between the two groups (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab4\\\" class=\\\"InternalRef\\\"\\u003e4\\u003c/span\\u003e). There were 84 live neonates in the follicular long-acting long protocol group and 204 live neonates in the antagonist protocol group. No statistically significant differences were detected between the two groups in gestational age distribution, including rates of extremely preterm birth (\\u0026lt;\\u0026thinsp;34 weeks), moderate preterm birth (34\\u0026ndash;37 weeks) and full-term birth (\\u0026ge;\\u0026thinsp;37 weeks) (all \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05). Additionally, the incidence of low birth weight, normal birth weight proportion, and macrosomia rate were also comparable between the two groups, with no significant inter-group differences observed (all \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05).\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab4\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 4\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eComparison of neonatal outcomes between the two groups of patients\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"5\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eIndicator\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eFollicular long-acting long protocol group (n\\u0026thinsp;=\\u0026thinsp;84)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eAntagonist protocol group (n\\u0026thinsp;=\\u0026thinsp;204)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eχ\\u0026sup2;\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eP\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eGestational age \\u0026lt;34\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e5.95(5/84)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e4.41(9/204)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.305\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.581\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eGestational age 34\\u0026ndash;37\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e11.90(10/84)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e14.71(30/204)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.390\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.532\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eGestational age\\u0026thinsp;\\u0026ge;\\u0026thinsp;37\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e82.14(69/84)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e80.88(165/204)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.062\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.803\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eProportion of low birth weight infants\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e14.29(12/84)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e14.71(30/204)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.008\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.927\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eProportion of normal birth weight infants\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e78.57(66/84)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e80.88(165/204)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.200\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.655\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eProportion of macrosomic infants\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e7.14(6/84)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e4.41(9/204)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.899\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.343\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec13\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e3.5 Multivariate Logistic Regression Analysis\\u003c/h2\\u003e \\u003cp\\u003eMultivariate logistic regression analysis was conducted to screen the independent influencing factors of clinical pregnancy rate. Covariates included age, BMI, infertility duration, infertility type, endometrial thickness, blood lipid indicators (TC, TG, LDL-C, HDL), high-quality embryo transfer status, and ovarian stimulation protocol. As shown in Table\\u0026nbsp;\\u003cspan refid=\\\"Tab5\\\" class=\\\"InternalRef\\\"\\u003e5\\u003c/span\\u003e, after adjusting for all confounding factors, only age was identified as an independent influencing factor for clinical pregnancy (\\u003cem\\u003eβ\\u003c/em\\u003e = -0.061, \\u003cem\\u003eaOR\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.940, \\u003cem\\u003e95%CI\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.885\\u0026ndash;1.000, \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.049). Specifically, advanced age was negatively correlated with the probability of clinical pregnancy, and the likelihood of clinical pregnancy decreased by approximately 6% per additional year of age. No statistically significant independent effects were found for other variables, including BMI, infertility duration, infertility type, endometrial thickness, all lipid metabolism markers, and high-quality embryo transfer (all \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05). Critically, when taking the follicular long-acting long protocol as the reference group, the antagonist protocol showed no significant difference in the adjusted odds of clinical pregnancy (\\u003cem\\u003eaOR\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.765, \\u003cem\\u003e95%CI\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.407\\u0026ndash;1.437, \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.404).\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab5\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 5\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eMultivariate Logistic Regression Analysis of Factors Influencing Clinical Pregnancy Rate\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"6\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eVariable\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eβ\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eSE\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eWald\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eaOR(95%CI)\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eP\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAge\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e-0.061\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.031\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e3.874\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.940(0.885-1.000)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.049\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBMI\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e0.000\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.039\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.000\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.000(0.926\\u0026ndash;1.080)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.995\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eInfertility duration (years)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e0.039\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.045\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.742\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.040(0.952\\u0026ndash;1.136)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.389\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eTypes of infertility\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e0.340\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.304\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1.252\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.405(0.774\\u0026ndash;2.551)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.263\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eEndometrial thickness\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e-0.016\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.073\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.051\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.984(0.853\\u0026ndash;1.134)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.822\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eTC\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e0.131\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.289\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.205\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.140(0.674\\u0026ndash;2.707)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.397\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eTG\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e-0.049\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.097\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.255\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.952(0.787\\u0026ndash;1.151)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.613\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eLDL\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e-0.328\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.364\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.813\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.720(0.353\\u0026ndash;1.470)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.367\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eHDL\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e-0.133\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.616\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.047\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.875(0.262\\u0026ndash;2.927)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.829\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eTransferred high-quality embryos\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e0.301\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.355\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.718\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.351(0.674\\u0026ndash;2.707)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.397\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eFollicular long-acting long protocol\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003ereference\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAntagonist protocol\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e-0.268\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.322\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.696\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.765(0.407\\u0026ndash;1.437)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.404\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"4. Discussion\",\"content\":\"\\u003cp\\u003eThis study systematically compared the efficacy, safety, and neonatal outcomes of the follicular long-acting long protocol versus the antagonist protocol in infertile patients with hyperlipidemia, and further explored independent predictors of clinical pregnancy using multivariate regression analysis. Our results demonstrated that the long protocol required a higher total gonadotropin dosage, longer stimulation duration, more retrieved oocytes, and better blastocyst formation potential. However, this regimen was also associated with a significantly elevated risk of moderate-to-severe ovarian hyperstimulation syndrome (OHSS). In contrast, the antagonist protocol shortened the treatment cycle, reduced gonadotropin exposure, and provided a more favorable safety profile. Most importantly, after adjusting for baseline differences in embryo transfer, no significant differences were observed between the two groups in key fresh-cycle reproductive outcomes, including clinical pregnancy rate, live birth rate, miscarriage rate, obstetric complications, and long-term neonatal outcomes. Regression analysis confirmed that only advanced maternal age was an independent negative risk factor for clinical pregnancy, whereas ovarian stimulation protocol and baseline blood lipid levels exerted no independent effect on pregnancy outcomes.\\u003c/p\\u003e \\u003cp\\u003ePrevious studies have suggested that prolonged exposure of oocytes and endometrium to high concentrations of gonadotropin can lead to a decline in oocyte quality and endometrial receptivity [\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e]. Some researchers have also reported that ovarian stimulation exceeding 13 days is associated with reduced clinical pregnancy and live birth rates in fresh cycles [\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e]. In the present study, compared with the long GnRH agonist protocol, the GnRH antagonist protocol significantly shortened the duration of ovarian stimulation [11.00 (10.00, 13.00) vs. 10.00 (9.00, 11.00), \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001] and reduced total gonadotropin consumption [2975.00 (2331.25, 3337.50) vs. 2625.00 (2093.75, 3271.88), \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.031]. Although the number of retrieved oocytes and blastocyst formation rate were higher in the agonist group, the blastocyst transfer rate showed an increasing trend in the antagonist group (26.15% vs. 31.69%), which might be attributed to the shorter stimulation duration and milder endocrine environment in antagonist cycles.\\u003c/p\\u003e \\u003cp\\u003eAlthough the antagonist protocol is widely recommended for patients at high risk of OHSS due to its favorable safety profile in reducing moderate-to-severe OHSS, some studies have suggested that the follicular long-acting long protocol may provide higher clinical pregnancy, implantation, and live birth rates in patients with normal ovarian response, and has been widely accepted by reproductive physicians worldwide. This discrepancy might be partially explained by the relatively unstable LH surge and impaired endometrial receptivity associated with antagonist protocols [\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e]. Furthermore, the expression level of HOXA10, a key regulator of endometrial proliferation, differentiation, and embryo implantation, was significantly lower in antagonist cycles than in the follicular long-acting long protocol cycles [\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e]. In addition, a study reported that endometrial AIF-1 expression was upregulated in antagonist cycles compared with the follicular long-acting long protocol, which may adversely affect embryo implantation by mediating TNF-α signaling [\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e]. However, all these studies were conducted mainly in normolipidemic populations rather than infertile patients with hyperlipidemia.\\u003c/p\\u003e \\u003cp\\u003eThe results of this study demonstrated that, compared with the long GnRH agonist protocol group, infertile patients with dyslipidemia who underwent ovulation induction using the GnRH antagonist protocol exhibited an upward trend in both clinical pregnancy rate (56.92% vs. 59.86%) and live birth rate (43.08% vs. 47.89%), although these differences did not reach statistical significance. This favorable trend might be attributed to the shorter duration of ovarian stimulation and the relatively higher proportion of blastocyst transfer in the antagonist protocol group, which may have counteracted the potential adverse effects of the antagonist regimen on endometrial receptivity. Previous studies have shown that dyslipidemia is closely associated with oocyte and embryo quality. Wang et al. [\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e] found that serum levels of TG, TC, and LDL were negatively correlated with embryo quality, while HDL levels were positively correlated with embryo quality. Liu et al. demonstrated that dyslipidemia was independently associated with a lower cumulative live birth rate in non-PCOS patients undergoing IVF/ICSI [\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e]. Jiang et al. found that elevated total cholesterol negatively impacts cumulative live birth rate in PCOS patients after the first ovarian stimulation cycle [\\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e]. Yang et al. [\\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e] reported that hyperlipidemia may increase the required gonadotropin dosage and exert adverse effects on embryo quality and endometrial receptivity during IVF in non-obese patients with polycystic ovary syndrome, thereby increasing the miscarriage rate. In the present study, the miscarriage rates in both groups were relatively high (24.32% and 20.00%, respectively), which was consistent with the above findings.\\u003c/p\\u003e \\u003cp\\u003eMultivariate logistic regression further confirmed that ovarian stimulation protocol was not an independent influencing factor for clinical pregnancy, whereas advanced age was the only independent risk factor; these results indicate that in patients with hyperlipidemia, the potential adverse effects of antagonist protocols on endometrial receptivity may be offset by metabolic and endocrine factors specific to this population, thereby achieving comparable reproductive outcomes with a safer stimulation profile. The major innovation of this study lies in its targeted focus on the special population of infertile patients with hyperlipidemia, rather than the general IVF population, which fills an existing evidence gap in protocol selection guidance for this patient subgroup. Our findings carry important clinical implications: for infertile women with hyperlipidemia, clinicians do not have to compromise overall pregnancy chances when choosing the antagonist protocol, as its shorter treatment course, lower drug consumption, and substantially reduced OHSS risk allow it to be safely and preferentially recommended\\u0026mdash;especially for patients with high OHSS susceptibility\\u0026mdash;without sacrificing ultimate reproductive efficiency or neonatal safety. Meanwhile, this study suggests that for patients with mild to moderate hyperlipidemia, routine individualized controlled ovarian stimulation can effectively offset the potential negative impact of dyslipidemia on treatment outcomes, and age remains the most critical prognostic indicator for clinical pregnancy, highlighting the need to emphasize timely fertility awareness and intervention during reproductive counseling.\\u003c/p\\u003e \\u003cp\\u003eNotably, this study has several limitations. First, it was a single-center retrospective analysis prone to selection bias, the relatively large sample size may still limit generalizability to diverse populations. Second, long-term neonatal outcomes were not followed up, including long-term physical growth and metabolic health status in childhood. Third, the molecular mechanisms underlying protocol-specific effects (e.g., oxidative stress markers or lipid metabolites in follicular fluid) remain unexplored. Thus, future large-scale multicenter prospective studies are required to validate these findings and further investigate the long-term safety and efficacy of different stimulation protocols in hyperlipidemic infertile patients.\\u003c/p\\u003e\"},{\"header\":\"5. Conclusions\",\"content\":\"\\u003cp\\u003eIn conclusion, the follicular long-acting long GnRH agonist protocol and the GnRH antagonist protocol achieve comparable clinical pregnancy and live birth rates in infertile patients with hyperlipidemia. The antagonist protocol is associated with shorter stimulation duration, lower gonadotropin consumption, and a lower risk of moderate-to-severe OHSS, supporting its preferential use in this population. Multivariate analysis confirmed that advanced age is the only independent negative predictor of clinical pregnancy, whereas ovarian stimulation protocol and baseline lipid levels have no independent effect. Routine lipid screening and individualized ovarian stimulation strategies should be emphasized to optimize reproductive outcomes in hyperlipidemic patients undergoing IVF/ICSI.\\u003c/p\\u003e\"},{\"header\":\"Abbreviations\",\"content\":\"\\u003cdiv class=\\\"DefinitionList\\\"\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eART\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eassisted reproductive technology\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eBMI\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003ebody mass index\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eE₂\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eestradiol\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eFET\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003efrozen-thawed embryo transfer\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eGn\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003egonadotropin\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eGnRH-a\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003egonadotropin-releasing hormone agonist\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003ehCG\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003ehuman chorionic gonadotropin\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eHDL-C\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003ehigh-density lipoprotein cholesterol\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eICSI\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eintracytoplasmic sperm injection\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eIVF\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003ein vitro fertilization\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eLDL-C\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003elow-density lipoprotein cholesterol\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eOHSS\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eovarian hyperstimulation syndrome\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eP\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eprogesterone\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003ePCOS\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003epolycystic ovary syndrome\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003ePGD\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003epreimplantation genetic diagnosis\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003ePGS\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003epreimplantation genetic screening\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eTC\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003etotal cholesterol\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eTG\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003etriglycerides\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003c/div\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e \\u003ch2\\u003eEthics approval and consent to participate\\u003c/h2\\u003e \\u003cp\\u003e This study was approved by the Ethics Committee of the Fourth Hospital of Shijiazhuang (approval number: 20240022). The study was performed in accordance with the Declaration of Helsinki. Waiver of informed consent was approved due to the retrospective nature without identifiable patient information.\\u003c/p\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003cstrong\\u003eConsent for publication\\u003c/strong\\u003e \\u003cp\\u003eNot applicable\\u003c/p\\u003e \\u003c/p\\u003e\\u003cp\\u003e \\u003ch2\\u003eCompeting Interests\\u003c/h2\\u003e \\u003cp\\u003eThe authors declare that they have no competing interests.\\u003c/p\\u003e \\u003c/p\\u003e\\u003ch2\\u003eFunding\\u003c/h2\\u003e \\u003cp\\u003eThis work was supported by grants from Medical Science Research Project of Hebei (No.20251111).\\u003c/p\\u003e\\u003ch2\\u003eAuthor Contribution\\u003c/h2\\u003e\\u003cp\\u003eX.-H.Z. and G.S. contributed equally to this work. X.-H.Z. and G.S. designed the study, analyzed the data, and wrote the main manuscript. X.-L.Z., Y.-J.D., and Y.-N.C. collected the clinical data. Y.J. and C.-P.G. supervised the project and revised the manuscript critically. All authors have read and approved the final manuscript.\\u003c/p\\u003e\\u003ch2\\u003eAcknowledgements\\u003c/h2\\u003e \\u003cp\\u003eWe thank all the staff in the center for reproductive medicine of the Center for Reproductive Medicine of the Fourth Hospital of Shijiazhuang.\\u003c/p\\u003e\\u003ch2\\u003eData Availability\\u003c/h2\\u003e\\u003cp\\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\u003cli\\u003e\\u003cspan\\u003eChen J, Fu D, Ma T, Chen M, Wang X, Yi J. Global burden of metabolic disorders among women of child-bearing age, 1990\\u0026ndash;2021: a population-based study1990-2021, BMC Womens Health. 2025;25(1):207.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eYang F, Lu JC, Shen T, Jin YH, Liang YJ. Effect of hyperlipidemia on the outcome of in vitro fertilization in non-obese patients with polycystic ovary syndrome. Front Endocrinol (Lausanne). 2023;14:1281794.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eCai WY, Luo X, Chen E, Lv H, Fu K, Wu XK, et al. Serum Lipid Levels and Treatment Outcomes in Women Undergoing Assisted Reproduction: A Retrospective Cohort Study. Front Endocrinol (Lausanne). 2021;12:633766.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eMeulders B, Marei WFA, Loier L, Leroy JLMR. Lipotoxicity and Oocyte Quality in Mammals: Pathogenesis, Consequences, and Reversibility. Annu Rev Anim Biosci. 2025;13(1):233\\u0026ndash;254.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eLambalk CB, Banga FR, Huirne JA, Toftager M, Pinborg A, Homburg R, et al. GnRH antagonist versus long agonist protocols in IVF: a systematic review and meta-analysis accounting for patient type. Hum Reprod Update. 2017;23(5):560\\u0026ndash;579.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eYang R, Guan Y, Perrot V, Ma J, Li R. Comparison of the Long-Acting GnRH Agonist Follicular Protocol with the GnRH Antagonist Protocol in Women Undergoing In Vitro Fertilization: A Systematic Review and Meta-analysis. Adv Ther. 2021;38(5):2027\\u0026ndash;2037.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eAl-Inany HG, Youssef MA, Ayeleke RO, Brown J, Lam WS, Broekmans FJ. Gonadotrophin-releasing hormone antagonists for assisted reproductive technology. Cochrane Database Syst Rev. 2016;4(4):CD001750.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eYang J, Zhang X, Ding X, Wang Y, Huang G, Ye H. Cumulative live birth rates between GnRH-agonist long and GnRH-antagonist protocol in one ART cycle when all embryos transferred: real-word data of 18,853 women from China. 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J Geriatr Cardiol. 2018;15(1):1\\u0026ndash;29.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eAlpha Scientists in Reproductive Medicine and ESHRE Special Interest Group of Embryology. The Istanbul consensus workshop on embryo assessment: proceedings of an expert meeting. Hum Reprod. 2011;26(6):1270-83.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eGardner DK, Lane M, Stevens J, Schlenker T, Schoolcraft WB. Blas-tocyst score affects implantation and pregnancy outcome: Towards a single blastocyst transfer. Fertil Steril 2000;73:1155\\u0026ndash;1158.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eKaleli S, Yanikkaya-Demirel G, Erel CT, Senturk LM, Top\\u0026ccedil;uoğlu A, Irez T. High rate of aneuploidy in luteinized granulosa cells obtained from follicular fluid in women who underwent controlled ovarian hyperstimulation. Fertil Steril. 2005;84(3):802\\u0026ndash;4.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003ePereira N, Friedman C, Hutchinson AP, Lekovich JP, Elias RT, Rosenwaks Z. Increased odds of live birth in fresh in vitro fertilization cycles with shorter ovarian stimulation. Fertil Steril. 2017;107(1):104\\u0026ndash;109.e2.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eLambalk CB, Banga FR, Huirne JA, Toftager M, Pinborg A, Homburg R,et al. GnRH antagonist versus long agonist protocols in IVF: a systematic review and meta-analysis accounting for patient type. Hum Reprod Update. 2017;23(5):560\\u0026ndash;579.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eYang R, Guan Y, Perrot V, Ma J, Li R. Comparison of the Long-Acting GnRH Agonist Follicular Protocol with the GnRH Antagonist Protocol in Women Undergoing In Vitro Fertilization: A Systematic Review and Meta-analysis. Adv Ther. 2021;38(5):2027\\u0026ndash;2037.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eWang Y, Hu S, Yao G, Sun Y. Identification of HOXA10 target genes in human endometrial stromal cells by RNA-seq analysis. Acta Biochim Biophys Sin (Shanghai). 2021;53(3):365\\u0026ndash;371.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eXu B, Zhou M, Wang J, Zhang D, Guo F, Si C, et al. Increased AIF-1-mediated TNF-α expression during implantation phase in IVF cycles with GnRH antagonist protocol. Hum Reprod. 2018;33(7):1270\\u0026ndash;1280.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eWang S, Wang J, Jiang Y, Jiang W. Association between blood lipid level and embryo quality during in vitro fertilization. Medicine (Baltimore). 2020;99(13):e19665.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eLiu Z, Cong J, Liu X, Zhao H, Lai S, He S, et al. Dyslipidemia Is Negatively Associated With the Cumulative Live-Birth Rate in Patients Without PCOS Following IVF/ICSI. Front Physiol. 2021;12:713356.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eJiang X, Lu X, Cai M, Liu Y, Guo Y. Impact of dyslipidemia on the cumulative pregnancy outcomes after first ovarian stimulation. Front Endocrinol (Lausanne). 2022;13:915424.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eYang F, Lu JC, Shen T, Jin YH, Liang YJ. Effect of hyperlipidemia on the outcome of in vitro fertilization in non-obese patients with polycystic ovary syndrome. Front Endocrinol (Lausanne). 2023;14:1281794.\\u003c/span\\u003e\\u003c/li\\u003e\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"european-journal-of-medical-research\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"ejmr\",\"sideBox\":\"Learn more about [European Journal of Medical Research](http://eurjmedres.biomedcentral.com)\",\"snPcode\":\"40001\",\"submissionUrl\":\"https://submission.nature.com/new-submission/40001/3\",\"title\":\"European Journal of Medical Research\",\"twitterHandle\":\"@BioMedCentral\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC/SO AJ\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Hyperlipidemia, Follicular long-acting long protocol, Antagonist protocol, IVF/ICSI, Pregnancy outcomes\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-9481660/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-9481660/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003eObjective\\u003c/h2\\u003e \\u003cp\\u003eTo investigate the application effects and fresh cycle pregnancy outcomes of the follicular long-acting long protocol and antagonist protocol in infertile patients with hyperlipidemia.\\u003c/p\\u003e\\u003ch2\\u003eMethods\\u003c/h2\\u003e \\u003cp\\u003eA retrospective analysis was conducted on the clinical data of 621 infertile patients with hyperlipidemia who underwent IVF/ICSI treatment at the Reproductive Medicine Center of our hospital from January 2021 to December 2023. Patients were divided into the follicular long-acting long protocol group (n\\u0026thinsp;=\\u0026thinsp;195) and the antagonist protocol group (n\\u0026thinsp;=\\u0026thinsp;426) based on the ovarian stimulation protocol. The baseline characteristics, ovulation induction and fresh cycle transplantation were compared between the two groups, and the main factors for pregnancy outcome such as age, body mass index (BMI), high-quality embryos transplantation, and ovulation induction protocols were evaluated by Logistic multivariate analysis.\\u003c/p\\u003e\\u003ch2\\u003eResults\\u003c/h2\\u003e \\u003cp\\u003eCompared with the follicular long-acting long protocol group, the antagonist protocol group had older age, longer infertility duration, lower proportion of primary infertility, fewer antral follicle count (AFC), fewer total Gn dosage, shorter gonadotropin (Gn) usage days, fewer retrieved oocytes, lower blastocyst formation rate, and lower incidence of ovarian hyperstimulation syndrome (OHSS) (all \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05). There were no significant differences between the two groups in body mass index (BMI), levels of estradiol (E₂) and progesterone (P) on the day of human chorionic gonadotropin (hCG) administration, endometrial thickness, number of high-quality embryos, proportion of blastocyst transfer, clinical pregnancy rate, live birth rate, miscarriage rate, preterm birth rate, or neonatal weight (all \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05). After adjusting for confounding factors such as age, BMI, and endometrial thickness, Logistic regression analysis showed that age was an independent factor affecting clinical pregnancy rate (\\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05), while the ovarian stimulation protocol had no significant impact on fresh cycle clinical pregnancy rate.\\u003c/p\\u003e\\u003ch2\\u003eConclusion\\u003c/h2\\u003e \\u003cp\\u003eSimilar clinical pregnancy outcomes can be achieved with the follicular long-acting long protocol and antagonist protocol in infertile patients with hyperlipidemia. The antagonist protocol offers advantages such as shorter Gn usage time and lower OHSS risk, making it a preferred option for this population.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Comparison of the Follicular Long-Acting Long Protocol and Antagonist Protocol in Infertile Patients with Hyperlipidemia\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2026-05-15 10:49:21\",\"doi\":\"10.21203/rs.3.rs-9481660/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"reviewerAgreed\",\"content\":\"168470999891294577447216738194111836739\",\"date\":\"2026-05-12T14:10:37+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewersInvited\",\"content\":\"\",\"date\":\"2026-05-06T09:25:53+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2026-04-30T13:16:16+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2026-04-29T11:24:02+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"European Journal of Medical Research\",\"date\":\"2026-04-28T22:55:56+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"european-journal-of-medical-research\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"ejmr\",\"sideBox\":\"Learn more about [European Journal of Medical Research](http://eurjmedres.biomedcentral.com)\",\"snPcode\":\"40001\",\"submissionUrl\":\"https://submission.nature.com/new-submission/40001/3\",\"title\":\"European Journal of Medical Research\",\"twitterHandle\":\"@BioMedCentral\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC/SO AJ\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"4a8a67b5-b158-4023-8061-6b76b8a748dc\",\"owner\":[],\"postedDate\":\"May 15th, 2026\",\"published\":true,\"recentEditorialEvents\":[{\"type\":\"reviewerAgreed\",\"content\":\"168470999891294577447216738194111836739\",\"date\":\"2026-05-12T14:10:37+00:00\",\"index\":68,\"fulltext\":\"\"},{\"type\":\"reviewersInvited\",\"content\":\"51\",\"date\":\"2026-05-06T09:25:53+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2026-04-30T13:16:16+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2026-04-29T11:24:02+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"under-review\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2026-05-15T10:49:21+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2026-05-15 10:49:21\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-9481660\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-9481660\",\"identity\":\"rs-9481660\",\"version\":[\"v1\"]},\"buildId\":\"XKTyCvWXoU3ODBz1xrDgd\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}