Comparison Of Effects Of 4 Triptorelin Down-regulation Protocols In COH And Factors

objective: To compare the efficacy of 3 early cessation protocols with the modified long protocol of triptorelin in IVF-ET/ICSI and factors.Methods: We retrospectively analyzed 1164 IVF-ET/ICSI cycles. We divided three groups according to the female age (<30y, 30-35y, >35y) and the infertile duration (<5years, 5-10years, >10years). Then divided two groups according to the basal FSH (<10.0mIU/ml, 10.0-12.0mIU/ml) and the type of infertility (primary infertility, secondary infertility). We comparied the pregnancy rate by Chi-square test. The cases were divided into 4 groups with different cessation protocols. Group A: 0.1mg triptorelin S.C every other day starting in midluteal phase of the prior menstrual cycle (day 21), stopped triptorelin on the day of gonadotropin (Gn) injection; group B: continued triptorelin up to and inclding day 4 of Gn administration; group C: continued triptorelin over day 4 of Gn administration but not inclding the day of hCG. Injection; group D: continued triptorelin up to and inclding the day of hCG. injection (modified long protocol). The outcome of 4 triptorelin protocols in induced ovulation for IVF was evaluated.Results: A total of 1164 IVF-ET/ICSI cases underwent 1164 cycles, 485 cases resulted in pregnancy. The pregnancy rate is 41.67%. Among them,181 cases ending in multiple pregnancies, occupy 37.32%; 25 cases resulting in ectopic pregnancy, and 83 cases was abortion. If the age >30y or the duration of infertility is more than 10 years, the pregnancy rate significantly lower (P<0.05). The pregnancy rate was 38.30% when bFSH>10.0mIU/ml and was not statistically different from the other group (P>0.05). In the patients with primary infertility the pregnancy rate was 40.56%, the other group was 42.63%, no statistical difference was observed. There were no significant differences in the duration of Gn administration, incidence of endogenous LH surge, biochemical pregnancy rate,clinical pregnancy rate, early abortion rate and incidence of OHSS (P>0.05) between 4 down-regulation protocols. The fertilization rate, cleavage rate, metaphase II oocytes rate and ET score in group A were lower than those of the patients in group B and C (P<0.05).Conclusion:①Female age and the duration of infertility have direct effects on the pregnancy rate. If the age >30y or the duration of infertility is more than 10 years, the pregnancy rate significantly lower.②When bFSH raised slightly (10.0～l2.0mIU/ml), it had the limited capability for predicting IVF outcome.③The type of infertility can not predict ongoing pregnancy.④Early cessation protocols provide down-regulation effects similar to modified long protocol and reduce the total number of triptorelin ampoules. The better effect occurs when triptorelin continues up to day 4 of Gn administration.