| Objective:To explore the effects of different triggering schemes on the in vitro fertilization-embryo transfer(IVF-ET)pregnancy outcomes in patients with ovarian reserve dysfunction in various superovulation ovulation programs,and to find a suitable trigger program to improve pregnancy rate and improve pregnancy outcome.Method:Retrospective analysis of 383 patients with ovarian reserve dysfunction who were assisted by in vitro fertilization and embryo transfer(IVF-ET)from October 2017 to October 1818,respectively.The regimen,the micro-stimulation regimen,and the ovulation-promoting regimen in the progesterone state promote ovulation,grouped according to the patient trigger protocol and the COH protocol.PartⅠ: Overall comparison based on different triggering schemes for DOR patients 383 patients with DOR were divided into two groups according to the trigger plan: GnRH-a+HCG trigger unit,HCG pull unit;170 cases,213 cases respectively;analysis and comparison of the basics of the two groups Conditions,timing,trigger daily hormone levels,superovulation,laboratory indicators,and pregnancy outcomes.Part Ⅱ: According to different groups of DOR patients applying COH scheme,compare the trigger schemes respectivelyPart of the antagonist program: patients with ovarian reserve dysfunction were selected as subjects,and 135 patients were ovulated by antagonist program.According to the trigger protocol,they were divided into GnRH-a+HCG and HCG plates;60 cases and 75 respectively.For example,the basic conditions of the two groups,Gn dosage and promotion time,trigger daily hormone levels,superovulation,laboratory indicators and pregnancy outcomes were compared.Part of the micro-stimulation program: patients with ovarian reserve dysfunction were selected as subjects,and micro-stimulation was used to induce ovulation.A total of 143 cases were divided into GnRH-a+ HCG and HCG plates according to the trigger protocol;60 cases were 78 cases;analysis and comparison of the two groups of basic conditions,Gn dosage and promotion time,trigger daily hormone levels,superovulation,laboratory indicators and pregnancy outcomes.patients with ovarian reserve dysfunction were selected as subjects,and ovulation induction programs under high progesterone status,a total of 105 cases,were divided into GnRH-a+HCG trigger units and HCG triggers according to different machine programs.Groups;50 cases,55 cases;analysis and comparison of the two groups of basic conditions,Gn dosage and promotion time,trigger daily hormone levels,super ovulation,laboratory indicators and pregnancy outcomes.Result:Part Ⅰ:Overall comparison: There were no significant differences in the number of eggs,mature eggs,available embryos,cleavage rate,cycle cancellation rate,egg retrieval rate,and high quality embryo rate between the two groups(P>0.05).However,the number of embryos available in the GnRH-a+HCG group was greater than that in the HCG group(2.47±1.22 VS 1.02±0.52),and the difference was statistically significant(P=0.046<0.05,P=0.040<0.05)。The fertilization rate in the GnRH-a+HCG group was higher than that in the HCG group[85.00%(544/640)VS 62.89%(300/477)] and the difference was statistically significant.There was no significant difference in cumulative pregnancy rate and abortion rate between the two groups,but the GnRH-a+HCG group was higher than the HCG group [33.89%(61/180)vs 19.11%(43/225)]Part Ⅱ:Antagonist program: There were no significant differences in the number of eggs,mature eggs,available embryos,cleavage rate,cycle cancellation rate,egg retrieval rate,and high quality embryo rate between the two groups(P>0.05).However,the number of embryos available in the GnRH-+HCG group was greater than that in the HCG group((2.55±1.22 VS 1.25±0.52),and the difference was statistically significant(P=0.035<0.05,P=0.047<0.05).The fertilization rate of GnRH-a+HCG group was higher than that of HCG group [84.71%(216/255)VS 62.09%(95/153)].The difference was statistically significant.There was no significant difference in the cumulative pregnancy rate between the two groups,but the GnRH-a+HCG group implantation rate.Higher than HCG group [ 34.42%(21/61)VS 22.85%(16/70)],P=0.045<0.05).Micro-stimulation scheme: There were no significant differences in the number of eggs obtained,the number of mature eggs,the number of available embryos,the number of high-quality embryos,the cleavage rate,the period of elimination,the rate of egg retrieval,and the rate of available embryos in the two groups(P> 0.05).The fertilization rate and high quality embryo rate in the GnRH-a+HCG group were higher than those in the group [85.80%(248/289)VS 56.67%(103/180)76.67.00%(46/60)VS55.13%(43/78)],the difference was statistically significant.There was no significant difference in the implantation rate,cumulative pregnancy rate,and abortion rate between the two groups.Part of ovulation induction in high progesterone status: number of eggs obtained,number of matured eggs,number of available embryos,number of high quality embryos,fertilization rate,cleavage rate,cycle cancellation rate,egg retrieval rate,available embryo rate There was no significant difference(P>0.05),but the quality of GnRH-a+HCG group was higher than that of HCG group(62.00%(31/50)VS 50.91%(28/55),the difference was statistically significant(P=0.043<0.05).There was no significant difference in the implantation rate between the groups,but the cumulative pregnancy rate in the GnRH-a+HCG group was higher than that in the HCG group[ 26.30%(10/38)VS 12.50%(5/40)],the difference was statistically significant(P=0.033< 0.05).Conclusion:1.GnRH-a+HCG trigger unit and HCG trigger unit overall comparison,GnRH-a+HCG trigger unit can increase the number of available embryos,fertilization rate and planting rate.2.In the antagonist program,the GnRH-a+HCG trigger unit can increase the number of available embryos,fertilization rate and planting rate.3.In the micro-stimulation program,GnRH-a+HCG trigger unit can improve fertilization rate and high quality embryo rate.4.In the ovulation induction program under high progesterone status,GnRH-a+HCG trigger unit can improve the quality of embryos and improve the cumulative clinical pregnancy rate. |
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