The Effect Of Various Dosage Of Long-acting And Short-acting Diphereline To Pituitary Descent Regulation And To The Result Of IVF-ET

Objective:Gonadotropin releasing hormone agonist (GnRH-a) can be used in vitro fertilization and embryo transfer( IVF-ET) of controlled ovarian hyperstimulation (COH). It can effectively inhibit occurrence of premature endogenous LH peak to improve the quality of ovum , facilitate monitoring of the growth of ovarian follicle and arrangements for taking ovarian follicle. The program of GnRH-a down-regulation could be affected by different formulations, dose and duration of down-regulation . So the degree of pituitary- ovarian axis down-regulation variate .With the affluence of various dosage and dosage forms of Diphereline to the adjustment of the pituitary gland and outcome of IVF-ET, this article aims to explore the reasonable way of pituitary down regulation and the modest dosage .Methods:All 152 patients will use long plan in luteal phase to carry on COH. According to the dosage-form and dosage of Diphereline, the patients were divided into four groups. Group A has 37 cases, with Long-acting Diphereline 1.25 mg intramuscular injection once in middle of luteal phase. Group B has 38 cases, with Long- acting Diphereline 1.1 mg intramuscular injection once in middle of luteal phase . Group C has 40 cases, with Short-acting Diphereline 0.1 mg/d in middle of luteal phase, reduce it to 0.05mg/d 3 days after menstruation until the administration of HCG. Group D has 37 cases, with Short-acting Diphereline 0.05 mg/d in middle of luteal phase, a daily subcutaneous injection until the administration of HCG .Results:(1)Three days later, the LH, E2 levels in all four groups of down regulation were not significantly different ( P<0.05) ( 2 ) Compare to group B, C, D, administration of HCG in the E2 levels in group A were significantly higher. (P<0.05) Difference was statistically significant. (3) Compare to group B, C, D, group A has the maximum dosage and the longest duration( P<0.05), difference between them was statistically significant. (4)In the number of ova obtained and high-quality embryos, fertilization rate, the embryo plant rate and the clinical rate of pregnancy, four groups do not have the significance ( P > 0. 05). The clinical pregnancy rate of group D was 40.5%, in group B,C,A they were 39.5%,37.5%,32.4% respectively. In group D and group B ,clinical pregnancy rate was slightly higher than group A and group C. ( P<0.05). But there was no significant difference.Conclusion:1. Four different doses of Diphereline application can reach the COS of pituitary down regulation.2. Due to the longer medication time and the higher dosage of Gn, the level of E2 on the administration of HCG will increase in the group of Long-acting Diphereline 1.25 mg . Thus,it will increase the risk of OHSS.3. The group of Long-acting Diphereline 1.25mg has increased the dosage and time . The dosage of GnRH-a could be diminished according to the patients'basic conditions.4.Persistent usage of GnRH-a 1.1 mg/d and the short usage of GnRH-a 0.05 mg/d can both achieve the reasonable control of the pituitary in ultra ovulation. It can also reduce the dosage and the duration of the use of Gn, while doesn't affect the result of IVF-ET.