The Influence Of Different Trigger Schemes On The Embryo Quality Of Patients With Decreased Ovarian Reserve

ObjectiveTo investigate the effects of trigger schemes of gonadotropin releasing hormone agonist(GnRH-a),human chorionic gonadotropin(HCG),and GnRH-a combined with HCG on the embryo quality of patients with decreased ovarian reserve(DOR).MethodsThe clinical and laboratory data of 2399 patients with decrease ovarian reserve who were assisted by in vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI)from January 2014 to December 2020 in the Reproductive Medicine Center of Qilu Hospital,Shandong University were retrospectively analyzed.The patients were grouped according to trigger scheme,age,BMI and the number of different dominant follicles on the trigger day and the effect of trigger schemes on embryo laboratory outcomes were compared.Results1.The number of oocytes retrieved and the rate of high-quality embryos in the GnRH-a+HCG group were significantly higher than those in the GnRH-a group(P<0.05).There was no significant difference in oocyte maturity rate,normal fertilization rate and blastocyst formation rate among the three trigger regimen groups(P>0.05).2.The number of oocytes retrieved,the high-quality embryo rate and the blastocyst formation rate in patients aged<35 years the GnRH-a+HCG group were higher than those in the GnRH-a group and the HCG group.3.The number of oocytes retrieved in the GnRH-a+HCG group was higher than that in the GnRH-a group in patients aged≥35 years(P<0.05).There were no significant differences in the normal fertilization rate,high-quality embryo rate and blastocyst formation rate among the three groups.4.When the patients were lean and of normal weight,the number of oocytes retrieved and the rate of high-quality embryos in the GnRH-a+HCG group were higher than those in the GnRH-a group(P<0.05).When the patients were overweight and obese the differences between trigger scheme groups gradually decreased.5.When the number of dominant follicles on trigger day was less than or equal to 2,the high-quality embryo rate in GnRH-a+HCG group was higher than that in HCG and GnRH-a groups(P<0.05).The difference between groups in the high-quality embryo rate gradually decreased.Conclusion1.The GnRH-a+HCG dual-trigger is beneficial to increasing the number of oocytes retrieved and the rate of high-quality embryos in DOR patients.2.For DOR patients aged<35 years,the GnRH-a+HCG dual-trigger can improve the number of oocytes retrieved,the rate of high-quality embryos and the rate of blastocyst formation;for DOR patients aged≥35 years,the advantage of the dual trigger scheme is not obvious.3.The dual-trigger scheme can improve the number of oocytes retrieved and the rate of high-quality embryos in patients with low body weight and normal body weight,and the advantage of the dual-trigger group gradually decreases with the increase of BMI.4.When the number of dominant follicles on trigger day was less than or equal to 2,the rate of high-quality embryos in GnRH-a+HCG group was higher than that in HCG and GnRH-a groups(P<0.05).However,with the number of dominant follicles on trigger day increased,the difference between the groups gradually decreased.5.There was no significant difference in the pregnancy rate of fresh embryo transfer among the three trigger scheme groups.The number of fresh embryo transfer patients included in this study was small,and the effect of different trigger schemes on pregnancy outcomes remains to be further studied.