| BackgroundAs assisted reproductive technology(ART)continues to evolve and improve,controlled ovarian stimulation(COS)is one of the key components of successful ART.The gonadotropin-releasing hormone agonist(GnRH-a),with its unique descending regulatory advantage in controlled ovulation,prevents the appearance of early endogenous luteinizing hormone(LH)peaks,achieves synchronization of follicle development and increases the number of eggs gained,improving embryo quality and the number of eggs gained.GnRH-a is widely used for the prevention of early onset endogenous luteinizing hormone(LH)peak,synchronization of follicular development and increase of egg production,improvement of embryo quality and clinical pregnancy rate.The dose and timing of the menstrual cycle of different preparations of GnRH-a vary in clinical practice,with different effects on the descending regulation of the pituitary gland,which ultimately affects the outcome of assisted conception,and therefore has been the focus of clinical discussion.During the treatment and management of infertility,a more optimal treatment plan should be selected with the aim of improving the quality of life of patients while ensuring clinical outcomes.PurposeWe investigated the differences between the full-dose GnRH-a descending regimen in the luteal phase and the full-dose GnRH-a descending regimen in the follicular phase,which has been widely promoted in recent years,as well as the conventional luteal phase regimen in in vitro fertilization(IVF)and intracytoplasmic sperm injection(ICSI).ICSI(intracytoplasmic sperm injection),and to investigate abnormal uterine bleeding during downregulation and to assess other quality of life before and after GnRH-a application in patients using the full-dose GnRH-a downregulation regimen for ovulation.Methods1.A total of 946 IVF/ICSI assisted conception patients who performed COS with long-acting long protocol at the Fertility Center of The Sixth Affiliated Hospital of Guangzhou Medical University between January 01,2018 and October 31,2022 were retrospectively analyzed,and were divided into three groups according to the timing and dose of GnRH-a pituitary downregulation,in which Group A(full-dose GnRH-a long-acting long protocol downregulation group in the luteal phase)71 cases,group B(follicular phase full-dose GnRH-a long-acting long regimen downregulation group)241 cases,and group C(conventional luteal phase long-acting long regimen downregulation group)634 cases.We collected and compared the differences in the relevant indexes of each regimen group in the descending regulation process,ovulation promotion process,embryonic condition and pregnancy outcome.2.A total of 63 patients with IVF/ICSI assisted conception using full-dose GnRH-a down-regulation long-acting long regimen for COS at the Fertility Center of the Sixth Hospital of Guangzhou Medical University between December 01,2022 and February 31,2023 were prospectively collected,including 34 cases in group A1(fulldose GnRH-a long-acting long regimen down-regulation group in the luteal phase)and group B1(full-dose GnRH-a long-acting long regimen in the follicular phase GnRH-a long-acting long regimen downregulation group,i.e.follicular phase longacting long regimen group)in 29 cases.Modified Kupperman score and irregular vaginal bleeding were collected at the time of patient enrollment and on the day of Gn initiation,respectively.ResultsPart 11.The comparison of bLH levels between the three groups was statistically different(p<0.05),but the difference in their absolute values was within the normal error range(6.92± 5.44 vs.6.96± 4.26 vs.6.25±3.69)and was not considered clinically significant;the comparison of other general conditions between the three groups was not statistically different(p>0.05).2.The total number of Gn was significantly higher in group C than in group B(2176.28±741.27 vs.1937.13±725.41,p<0.05)between the three groups,and there was no significant difference in the comparison of the total number of Gn between group A and group B and group A and group C.The total number of Gn days was significantly higher in group A than in group C(10.80± 1.66 vs.10.23± 1.41,p<0.05),group B The total number of Gn days in group A was significantly higher than that in group C(10.61 ± 1.49 vs.10.23± 1.41,p<0.05),and there was no significant difference in the total number of Gn days between group A and group B.The number of eggs obtained in group B was significantly higher than that in group C(13.86±5.89 vs.12.86±4.86,p<0.05),and there was no significant difference in the number of eggs obtained between group A and group B,and between group A and group C.The fertilization rate of 2PN in IVF was significantly higher in group A than in group B(69.42%vs.64.55%,p<0.05),and the fertilization rate of 2PN in group C was significantly higher than in group B(68.29%vs.64.55%,p<0.05),and there was no significant difference in the normal fertilization rate between group A and group C.There was no statistically significant difference in HCG daily sex hormone levels(FSH,LH,E2,P),fertilization rate of 2PN in ICSI,embryo number,and blastocyst formation rate comparing patients between the three groups(p>0.05).3.The rate of whole embryo freezing in group A was significantly lower than that in groups B and C(23.94%vs.39.00%vs.39.75%,p<0.05),and there was no significant difference in the rate of whole embryo freezing between groups B and C.The rate of cycle cancellation,the percentage of reasons for transfer cancellation(moderate to severe ovarian hyperstimulation syndrome(OHSS),mild OHSS,endometrial thinning,endometrial polyp,cavity effusion,high progesterone,vaginitis,OHSS prevention and others)were not statistically different among the three groups.syndrome(OHSS),mild OHSS,endometrial thinning,endometrial polyps,uterine effusion,high progesterone,vaginitis,prevention of OHSS and others)were not statistically different among the three groups(p>0.05).4.The embryo transfer rates among the three groups were 76.06%in group A,60.17%in group B,and 58.20%in group C.The embryo transfer rates in group A were significantly higher than those in groups B and C(76.06%vs.60.17%vs.58.20%,p<0.05),and there was no significant difference in the embryo transfer rates between groups B and C.A total of 335 oocytes were transferred in the three groups.There was no statistically significant difference in the total number of transferred embryos,endometrial thickness on the day of transfer,implantation rate,clinical pregnancy rate,biochemical pregnancy rate,ectopic pregnancy rate,and miscarriage rate between the three groups(p>0.05);235 blastocysts were transferred in the three groups,including 26 in group A,65 in group B,and 144 in group C.In terms of implantation rate,there was no significant difference between groups A and B,and between groups A and C.In terms of implantation rate,there was no significant difference between groups A and B,and group A and group C.Group B was significantly higher than group C(69.57%vs.51.63%,p<0.05);in terms of clinical pregnancy rate,there was no significant difference between groups A and B,and group B had a significantly higher clinical pregnancy rate than group C(67.69%vs.50.69%,p<0.05),and group A and group C had a non-significant difference in clinical pregnancy rate.There was no statistically significant difference in the total number of embryos transferred,endometrial thickness on the day of transfer,biochemical pregnancy rate,ectopic pregnancy rate,and miscarriage rate between the three groups(p>0.05).Part 21.There was no statistical difference in general condition between group A1 and group B1(p>0.05).2.The rate of abnormal uterine bleeding and duration of abnormal bleeding were significantly higher in group B1 than in group A1(65.52%vs.17.65%,p<0.05;7.00±6.15 vs.0.88±2.10,p<0.05),and there was no statistical difference in the comparison of menstrual cycle and duration of menstruation between the two groups.3.The absolute values of Kupperman scores were higher after down-regulation in either group A1 or B1,although the differences were not statistically significant.Conclusions1.The full-dose GnRH-a downregulation regimen in the luteal phase achieved similar clinical outcomes to the full-dose long-acting follicular phase regimen in both embryo implantation rates and clinical pregnancy rates.2.The full-dose GnRH-a downregulation regimen during the luteal phase reduces the rate of abnormal uterine bleeding and deserves to be promoted as a more optimal option to assist pregnancy. |
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