| Part I Analysis of influencing factors trigger day progesterone（P）levels elevation in people with different ovarian responses in progestin primed ovarian stimulation（PPOS）and the follicular phase long-acting Gn RH agonist long protocol.Objective: To explore whether there are different factors influencing the increase of P level on trigger day in patients with different ovarian responses in two ovulation induction schemes.Methods: The clinical data of 753 cycles of assisted reproductive technology in three reproductive centres in China from January 2018 to August 2021 were retrospectively analyzed,including 484 cycles of PPOS protocol（group A）and 269 cycles of the follicular phase long-acting Gn RH agonist long protocol（group B）.Patients in the group A were divided into two subgroups,good ovarian response（A1）and poor ovarian response（POR）（A2）,and patients in the group B were divided into two subgroups,good ovarian response（B1）and POR（B2）.Univariate and multivariate logistic regression analysis were used to investigate the risk factors of trigger day P elevation（P>1.5ng/m L）in group A1,A2 and B1.（Group B2 has a small sample size and is not analyzed）Results: 1.Univariate logistic regression analysis showed that in A1 group,increased AFC,E2 on trigger day and number of oocytes retrieved were risk factors for P elevation on trigger day（OR>1,P<0.05）;In A2 group,increased b FSH、b LH and trigger day LH were risk factors for P elevation on trigger day（OR>1,P<0.05）;In group B1,decreased BMI（OR<1,P<0.05）and increased of high purity FSH dose for ovulation induction,E2 on trigger day and number of oocytes retrieved were risk factors for P elevation on trigger day（OR>1,P<0.05）.2.Multivariate logistic regression analysis showed that the increase of E2 on trigger day in A1 group was a independent risk factor for P elevation on trigger day（OR>1,P<0.05）;In A2 group,elevated b LH and LH on trigger day were independent risk factors for P elevation on trigger day（OR>1,P<0.05）.In group B1,decreased BMI（OR<1,P<0.05）,increased ovulation high purity FSH dose and E2 on trigger day were independent risk factors for P elevation on trigger day（OR>1,P<0.05）.Conclusion: The influencing factors of P level increase on trigger day are different in patients with two different ovulation induction schemes and different ovarian responses.Effective intervention measures can be taken to prevent P level increase on trigger day according to different influencing factors.Part II The effect of progesterone/oocytes retrieved（P/O）on trigger day on embryo laboratory outcome and pregnancy outcome of the first frozen-thawed embryo transfer（FET）in patients with different ovarian reactivity in two ovulation induction schemes.Objective: To investigate the effect of trigger day P/O on embryo quality and FET pregnancy outcome in patients with different ovarian response in two ovulation induction regimens.Methods: In group A1,A2 and B1,according to the trigger day P/O level,patients in each group were divided into three subgroups: P/O≤0.17,0.17 0.34.The general situation of patients and the outcome indicators of embryo laboratory were compared respectively among three subgroups in each group;The patients in the A1,A2,and B1 group who underwent the first FET were divided into three subgroups,P/O≤0.17,0.17 0.34,according to the P/O level on the trigger day.The general conditions and clinical pregnancy rate of the first FET were compared among the three subgroups in each group.Results: 1.In group A1,P/O≤0.17,0.17 0.34 groups showed statistically significant differences in BMI,AFC,AMH and b FSH（P<0.05）.Before baseline data correction,The normal fertilization rate,cleavage rate and transferable embryo rate in 0.17 0.34 group were significantly higher than those in P/O≤0.17 group（P<0.05）.After adjusting baseline data,there were no significant differences in MII oocyte rate,normal fertilization rate,cleavage rate,optimal embryo rate and transferable embryo rate among the three subgroups（P>0.05）.2.In group A2,P/O≤0.17,0.17 0.34 had no statistical difference in baseline data.There were no significant differences in MII oocyte rate,normal fertilization rate,cleavage rate,optimal embryo rate and transferable embryo rate among the three groups（P>0.05）.3.In group B1,the three subgroups showed statistical differences in age,AFC and b FSH.There were no significant differences in MII oocyte rate,normal fertilization rate,cleavage rate,optimal embryo rate and transferable embryo rate among the three subgroups before and after baseline data correction（P>0.05）.4.Among the patients undergoing the first FET in A1,A2 and B1 groups,there were no statistical differences in clinical pregnancy rate of the first FET among the three subgroups（P>0.05）.Conclusion: The increase of P/O on trigger day had no effect on the embryo quality and the clinical pregnancy rate of the first FET in the patients with good ovarian response in the two ovulation induction schemes and the POR patients in the PPOS scheme.Therefore,frozen-thawed embryo transfer can be considered for patients with elevated P/O on trigger day. |
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