| Objective: The propensity score matching method(PSM)was applied to compare the results of in-vitro fertilization/ intracytoplasmic sperm injection(IVF/ICSI)treatment in patients with polycystic ovary syndrome(PCOS)infertility.The clinical and laboratory parameters and pregnancy outcomes of the pretreatment group of polycystic ovary syndrome(PCOS)patients treated with gonadotrophin-releasing hormone antagonist(Gn RH-ant)were compared with those of the untreated group.To investigate the clinical efficacy of Gn RH-ant pretreatment in PCOS patients with fresh embryo transfer in Gn RH-ant regimen.Methods: Retrospective analysis of clinical data of 202 pretreated and 200 unpretreated PCOS infertile patients treated with IVF/ICSI at the Center of Reproductive Medicine and Genetics of the People’s Hospital of Guangxi Zhuang Autonomous Region from January 2016 to December 2019,using the Gn RH-ant protocol for ovarian controlled ovarian stimulation(COS).After controlling for confounding factors between the two groups by PSM,132 cases in the pretreated group and 132 cases in the untreated group were obtained by matching.By comparing the baseline data,changes in serum hormone levels during COS,COS medication,endometrial thickness on trigger day,total fertilization rate,blastocyst conversion rate,high-quality blastocyst rate,freezable blastocyst rate,2PN egg cleavage rate,2PN rate,D3high-quality embryo rate,ovarian hyperstimulation syndrome(OHSS),cycle cancellation rate,live birth rate,embryo implantation rate,biochemical pregnancy rate,clinical pregnancy rate,multiple pregnancy rate,miscarriage rate,etc.,to analyze the clinical efficacy of Gn RH-ant pretreatment in PCOS patients who underwent fresh embryo transfer with Gn RH-ant protocol.Results:(1)Comparison of the basic characteristics of patients in the two groups before and after PSM: a total of 402 patients were collected,202 cases were matched in the pretreatment group of Gn RH-ant,and 200 cases were matched in the untreated group.There were statistically significant differences in follicle-stimulating hormone(FSH),luteotropic hormone(LH),basal estrogen(E2),and progesterone(P<0.05);age,years of infertility,body mass index(BMI),There were no significant differences in basal testosterone(Testoserone,T),basal antral follicle count(AFC),infertility factors,and fertilization mode(P>0.05).After PSM,there were 132 cases in the Gn RH-ant pretreatment group and 132 cases in the untreated group,and there was no significant difference in the basic characteristics between the two groups(P>0.05).(2)Comparison of hormonal changes and endometrial conditions at different time points during stimulation between the two groups: there was no significant difference in LH,FSH and P on the initiation day between the two groups(P>0.05).The E2 level on the initiation day of the pretreatment group was lower than that in the untreated group,and the difference was statistically significant(P<0.05).There was no significant difference in the comparison of daily E2 addition between the two groups(P>0.05).The LH and P levels in the antagonist addition daily pretreatment group were higher than those in the untreated group,and the differences were statistically significant(P<0.05).There were no significant differences in intraday film thickness,E2 and P between the two groups(P>0.05).The LH level in the h CG daily pretreatment group was higher than that in the untreated group,and the difference was statistically significant(P<0.05).(3)Comparison of hormone medication during ovulation induction between the two groups: there was no significant difference in Gn dosage and Gn days in COS between the two groups(P>0.05).The total amount of antagonists used in the pretreatment group was higher than that in the untreated group,and the difference was statistically significant(P<0.05).The amount of antagonist after initiation in the untreated group was significantly higher than that in the pretreatment group,and the difference was statistically significant(P<0.05).(4)Comparison of ovulation induction results between the two groups: There were no significant differences in egg acquisition,MII egg rate,total fertilization rate,blastocyst conversion rate,high-quality blastocyst rate,freezing blastocyst rate and embryo implantation rate between the two groups(P>0.05).The 2PN cleavage rate in the pretreatment group was higher than that in the untreated group and the difference was statistically significant(P<0.001),the 2PN rate in the pretreatment group was higher than that in the untreated group(P=0.007),and the D3 quality embryo rate in the pretreatment group was significantly higher than that in the untreated group(P=0.01).(5)Comparison of cycle safety between the two groups: 64 patients underwent fresh embryo transfer in the pretreatment group and 64 patients underwent fresh embryo transfer in the untreated group,and there was no significant difference in the incidence of OHSS and cycle cancellation rate between the two groups(P>0.05).(6)Comparison of pregnancy outcomes between the two groups: there were no significant differences in live birth rate,embryo implantation rate,biochemical pregnancy rate,clinical pregnancy rate,multiple pregnancy rate,and miscarriage rate between the two groups(P>0.05).(7)Negative binomial multivariate regression analysis showed that in the fresh embryo transfer of Gn RH-ant protocol in PCOS patients,the rate of D3 quality embryos increased as the E2 level on the initiation day decreased(OR=1.03.95%CI=1.01-1.09,P=0.041)。Conclusion:(1)The use of Gn RH-ant pretreatment in the IVF/ICSI fresh embryo cycle in PCOS patients adjusted the endocrine status of PCOS patients before initiation through a similar down-regulation effect,preventing the rapid rise of E2 during early follicle recruitment,and avoiding excessive inhibition of LH in the late follicular phase to affect the final development and maturation of eggs,thereby improving the rate of D3 high-quality embryos.(2)There was no difference in endometrial thickness between the pretreatment group and the non-pretreatment group on trigger day,and no effect of Gn RH-ant pretreatment on endometrial receptivity was found.(3)After the start of the pretreatment group,the total amount of antagonists decreased,and the daily LH level of HCG increased,which did not increase the cycle cancellation rate and OHSS incidence,reduced the inhibition time and degree of Gn RH-ant on late follicular stage LH,and improved egg quality,normal fertilization rate and high-quality embryo rate.(4)Whether PCOS patients use Gn RH-ant pretreatment in IVF/ICSI fresh embryo cycle has no significant effect on pregnancy outcome. |
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