| BackgroudIn recent years,the incidence of infertility has increased year by year,and GnRH-a long protocol is the main controlled ovarian hyperstimulation regimen in ovulatory women who account for the main part of infertility patients.Oral contraceptive pill pretreatment is helpful to schedule the treatment of IVF-ET and reduce the number of ovarian cysts in the GnRH-a long protocol,however its influences on the ovulation induction response and pregnancy outcomes are vague,and this research focuses on the effects that OCP pretreatment prior to GnRH-a long protocol has on the pregnancy outcomes of ovulatory women.ObjectiveTo research the effect of oral contraceptive pill pretreatment on GnRH-a long protocol in women of childbearing age with regular menstruation.MethodsThis study retrospectively analyzed the patients who received the first cycle of IVF or ICSI in the affiliated Reproductive Hospital of Shandong University from July 2015 to March 2017.A total of 1889 patients who underwent fresh embryo transfer were selected,including OCP preteatment group(n=838)and non-OCP preteatment group(n=1051).The basic characteristics,ovulation induction response and pregnancy outcomes of the two groups were compared.According to the type of OCP,OCP pretreatment group was divided into Diane-35 group(101 cases)and Yasmin group(737cases).The characteristics of ART were compared between OCP subgroups.The main targets of this study are the fresh live birth rate and the cumulative live birth rate within two years after egg retrieval.Results1.Comparison of basic characteristics between the two groupsThere were significant differences in age,AMH,basic FSH,body mass index(BMI)and the proportion of primary infertility between OCP group and non-OCP group(control group).The age of patients in OCP group was younger than that in non-OCP group(30.72±3.94vs.31.63±4.19,P<0.001),AMH was higher than that in non-OCP group(4.72±2.62vs.3.74±2.31,P<0.001).The basic FSH level in the control group was higher than that in the OCP pretreatment group(6.74±1.32vs.6.60±1.37,P=0.025).Body mass index(BMI)in OCP group was higher than that in control group(23.50±3.57VS.22.94±3.35,P=0.001).The proportion of patients with primary infertility in the OCP group was higher than that in the control group(51.4%vs.45.3%,P=0.008).2.Comparison of related data of ovulation induction medication and ovulation induction response between the two groupsThere was no significant difference in the days of stimulation,total dosage of Gn,P on the day of HCG,E2 on the day of HCG,endometrium thickness on HCG day,number of oocytes retrieved,fertilization rate,number of embryos obtained and number of D3 high quality embryos between the two groups.The amount of Gn on start day in OCP group was significantly lower than that in control group(149.78±38.31vs.158.06±40.29,P<0.001).The LH on day of HCG in OCP group was lower than that in non-OCP group(2.39±1.20vs.2.56±1.14,P=002),and the difference was statistically significant.3.Comparison of pregnancy outcome between the two groupsThe inclusion criteria of this study are that patients had fresh embryo transfer.In the fresh embryo transfer cycle,the proportion of cleavage fresh embryo transfer cycle(74.8%vs.75.3%,P=0.826)and the number of transferred embryos(1.70±0.46vs.1.71±0.45,P=0.768)are comparable between two groups.The biochemical pregnancy rate(67.8%vs.63.0%,P=0.030),clinical pregnancy rate(61.6%vs.54.9%,P=0.004),embryo implantation rate(46.8%vs.41.0%,P=0.001)and live birth rate(54.1%vs.47.5%,P=0.004)in the OCP pretreatment group were higher than those in the non-OCP pretreatment group,and the difference was statistically significant.There was no significant difference in early abortion rate between the two groups(13.2%vs.15.8%,P=0.225).There were 343 frozen embryo transfer cycles in OCP group and 525 frozen embryo transfer cycles in non-OCP group.The clinical pregnancy rate of the frozen embryo transfer cycle in the OCP group was higher than that in the control group(56.9%vs.49.5%,P=0.035).There was no significant difference in the early abortion rate and the live birth rate of frozen embryos between the two groups.In this study,multivariable logistic regression and multivariable Cox regression models were used to analyze the effects of oral contraceptive pretreatment on fresh live birth rate and cumulative live birth rate,respectively.The results showed that oral contraceptive pretreatment was related to higher fLBR(adjustment model OR1.27,95%CI 1.05-1.54,P=0.01).However,it had no significant effect on the cumulative live birth rate(adjusted model HR1.09,95%CI 0.97-1.22,P=0.15).Kaplan-Meier analysis of cumulative live birth rate showed that the cLBR in OCP pretreatment group was significantly higher than that in non-OCP pretreatment group(log-rank test,P<0.001).4.Comparison of ovarian response and pregnancy outcome in different types of OCP subgroups.In this study,oral contraceptive was used to treat with Diane-35 and Yasmin.The oral contraceptive pretreatment group was divided into Diane-35 group and Yasmin group according to the drug type.There was no significant difference in age,AMH,basic FSH,BMI and the type of infertility between the two groups.The LH on day of HCG in Daying-35 group was lower than that in Yasmin group(1.5410.64vs.2.51 ± 1.21,P<0.001).The endometrium thickness on day of HCG in Daying-35 group was thinner than that in Yasmin group(1.06±0.18vs.1.15±0.41,P=0.026).There was no significant difference in total Gn,days of stimulation,number of oocytes retrieved and embryos obtained between the two groups.During the fresh embryo transfer cycle,the biochemical pregnancy rate(52.5%vs.69.9%,P<0.001),clinical pregnancy rate(44.6%vs.63,9%,P<0.001)and live birth rate(36.6%vs.56.4%,P<0.001)in the Daying-35 group were lower than those in the Yasmin group,but there was no significant difference in the cumulative live birth rate(66.3%vs.74.2%,P=0.093)between the two groups.ConclusionsThe results of this study show that for patients with regular menstruation and GnRH-a long protocol,oral contraceptive pill pretreatment before ovulation induction without increasing the duration and dosage of ovulation induction is beneficial to obtain a better fresh live birth rate,but has no significant effect on the cumulative live birth rate within two years after oocytes retrieval. |
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