Comparison Of The Long GnRH Agonist Protocols During Early Follicular Phase And The Antagonist Protocols In Normal Responders

Background: Infertility refers to the couples who have normal sexual life and who cohabit for more than 1 year without contraceptive measures and cannot make the woman pregnant.It seriously affects the family happiness and the quality of life of the couples of childbearing age.According to the clinical statistics of multiple countries and centers in the 1980s(involving 33 centers in 25 countries,including 10 developed countries and15 developing countries),there are at least 80 million infertile couples in the world .Prevalence in the normal population is 9%-18%.The prevalence rate in China is about5%.The birth of the first test-tube baby in 1978 led to the rapid development of assisted reproduction technology,bringing infertility patients the dawn of having their own babies.Gonadotrophin releasing-hormone Agonist(GnRH-A)and Gonadotrophin releasinghormone antagonist(GnRH-ANT)are used In Vitro Fertilization Fresh Embryo Transfer.IVF-ET was an effective way to control endogenous Luteinizing Hormone(LH)peaks in Controlled Hyperstimulation(COH),from which GnRH-A protocols and GnRH-ANT protocols were extended for COH.At present,GnRH-A long protocols and GnRH-ANT protocols,which are the mainstream of GnRH-A protocols,had more clinical effects in Polycystic Ovarian Syndrome(PCOS),advanced age and Poor Ovarian Response(POR)[5-7].In recent years,due to its advantages of improving endometrial receptivity,improving pelvic microenvironment,increasing embryo implantation rate and clinical pregnancy rate,and reducing abortion rate,the long-acting GnRH-A in follicular period has been gradually selected as the mainstream protocols by some reproductive centers.GnRH-Ant also has the advantages of effectively reducing the occurrence of OHSS,short ovulation induction period,low dosage of GN,no "flare-up" effect,no cyst,retention of pituitary reactivity,etc.It is the preferred protocols of many reproductive centers.However,in patients with normal response,there are few data related to t the Long GnRH Agonist Protocols during Early Follicular Phase and t the Antagonist Protocols.In order to better benefit patients,this paper will analyze the application of the two treatments in the reproductive center in the normal population.Objective: To compare the outcome of the Long GnRH Agonist Protocols during Early Follicular Phase and the Antagonist Protocols in normal responders.Methods: The case data of patients with normal ovarian response who underwent IVF/ICSI in Reproductive Medicine Center of Taihe Hospital of Shiyan City from January 2018 to December 2020 were retrospectively analyzed.According to the ovulation induction scheme,the patients were divided into two groups: the Long GnRH Agonist Protocols during Early Follicular Phase group(Group A)and the Antagonist Protocols group(Group B).The general condition,ovulation induction monitoring,in vitro fertilization embryo development and pregnancy outcome were compared and analyzed.Results:(1)The dosage of the gonadotrophin(Gn)consumption[(2494.43±618.08)IU/L],the days of the Controlled Ovarian Hyperstimulation(COS)[(11.97±1.85)days],the thickness of the endometrial on Human Chorionic Gonadotropin(HCG)day [(11.13±2.65)mm],the ratio of the type A endometrial on HCG day(85.59%)were significantly increased with that of group B[(2274.14±581.12)IU/L],(10.16±1.59)days,(10.77±2.32)mm,(80.23%)],the difference was statistically significant(P<0.05).(2)The serum LH level of group A on HCG day was lower than that of group B [(0.94±0.82 VS 2.00±1.41)IU/L,P<0.05].The number of follicles(12.79±5.81),eggs(16.19±7.99),mature eggs(14.18±7.43),blastocyst formation rate(47.04%)and high quality blastocyst formation rate(92.69%)in group A were higher than those in group B [(12.79±5.81),(14.32±6.84),(12.12±56.65),(26.51%)and(85.09%)on HCG days(P<0.05)].The number of D3 available embryos [(7.21±4.53)VS(6.78±4.43),P>0.05],the number of high-quality cleavage embryos [(4.93±3.53)VS(4.64±3.57),P>0.05],and the rate of D3 optimal embryo [(57.39% VS57.29%),P>0.05]were not significantly different between the two groups.(3)The cancellation rate of fresh cycle embryo transfer in group A was lower than that in group B(31.36% VS 58.19%,P<0.05).Among the reasons for cancellation,the proportion of high serum progesterone(15.25% VS 58.19%,P<0.05)and prevention of the occurrence of OHSS(2.08% VS10.73%,P<0.05)in group A was lower than that in group B.The embryo implantation rate(43.62% VS 27.66%V,P<0.05)and clinical pregnancy rate(60.49% VS 42.67%,P<0.05)in group A were higher than those in group B.There was no significant difference in pregnancy rate,biochemical pregnancy rate,abortion rate and premature birth rate between the two groups.Conclusion: For patients with normal response,considering the cancellation of fresh embryo transfer period rate,fresh embryo transfer cycle pregnancy rate,fresh embryo implantation rate and high quality blastocyst formation rate,using the Long GnRH Agonist Protocols during Early Follicular Phase will benefit more.