| Objective:1.To compare the effects of a short 7-day gonadotropin -releasing hormone agonist(GnRH-a)protocol and a GnRH-a long protocol as part of controlled ovarian stimulation(COS)regimens during in vitro fertilization and embroy transfer(IVF-ET)treatment.2.To explore the individual influence on the IGF-Ⅱand IGFBP-4 levels in follicular fluid between the short 7-day GnRH-a protocol and GnRH-a long protocol.Methods:One hundred and forty six infertile patients with tubal factor were included in this study from July to November,2007.They were assigned into short 7-day GnRH-a protocol group(68 cases)and GnRH-a long protocol group(78 cases).All the cases of the short 7-day GnRH-a protocol group received GnRH-a injection with dosage of 0.1 mg daily from the 2ndday of the menstrual cycle to the 8thday.At the same time,gonadotropin(Gn)was injected daily from the 3rdday.In the GnRH-a long protocol group,1.88 mg of GnRH-a was injected singly in the mid-luteal phase of previous menstrual cycle.Once the pituitary function was down regulated,gonadotropin injection started.The states of follicular development and endometrial thickness as well as endometrial triple-layer structure were monitored by transvaginal ultrasonography.Total dosage of Gn used,the periods for treatment,numbers of total and mature oocytes retrieved,the rate of fertilization,cleaved embryos,top-quality embryos,implanation, pregnancy and clinical abortion were recorded and compared.On the day of human chorionic gonadotrophin(hCG)injection,serum luteinizing hormone(LH),estradiol(E2)and progesterone(P)were measured by electrochemiluminescence immunoassay.Follicular fluid was obtained from dominant follicles during oocyte retrieval.The levels of IGF-Ⅱand IGFBP-4 in follicular fluid were detected separately by radioimmunoassay and enzyme-linked immunosorbent assay.All the data was analysed by using software engineering SPSS13.0.Results:1.The level of serum progesterone on the day of hCG injection was lower in the short 7-day GnRH-a protocol group comparing with the GnRH-a long protocol group(0.58±0.51ng/ml vs 0.83±0.54 ng/ml,P＜0.05).There were no significant differences in the levels of serum LH,E2,E2 per oocyte and E2 per mature follicle on the day of hCG injection.2.Patients in the short 7-day GnRH-a protocol group were stimulated for a shorter period(8.97±1.45 d vs 11.41±1.43 d,P＜0.05),injected fewer Gn ampoules(1851.65±616.96IU vs 2726.44±769.28IU,P＜0.05),comparing with patients in the long protocol group. The endometrial thickness(9.80±1.82mm vs 10.55±1.65mm,P＜0.05) on the day of hCG injection was thinner in the short 7-day GnRH-a protocol group.The appearance rate of endometrial triple-layer structure was similar in the two groups.3.There were no statistically differences between the two groups in the numbers of total and mature oocytes retrieved,fertilization rate,cleaved embryos rate,top-quality embryos rate,implantation rate,pregnancy rate and clinical abortion rate. 4.The levels of IGF-Ⅱ(0.17±0.06 ng/ml vs 0.20±0.07ng/ml,P＜0.05) and IGFBP-4(2915.48±1443.02 pg/ml vs 3646.64±1818.67pg/ml,P＜ 0.05)in follicular fluid of the short 7-day GnRH-a protocol group patients were significantly lower.There was no significant difference in the ratio of IGF-Ⅱ/IGFBP-4(0.07±0.04vs 0.07±0.03,P＞0.05).5.Linear correlation analysis showed that the level of follicular fluid IGF-Ⅱwas positively correlated to total dose of Gn injected(r=0.316,P＜0.05).Conclusions:1.The short 7-day GnRH-a protocol and GnRH-a long protocol had equal effects on controlled ovarian stimulation and pregrancy outcomes for in vitro fertilization and embroy transfer treatment.Patients who received the short 7-day GnRH-a protocol required fewer dosages of gonadotropin and shorter periods of treatment than those who received the GnRH-a long protocol.2.The short 7-day GnRH-a protocol may affect the levels of follicular fluid IGF-Ⅱand IGFBP-4.However,the changes of follicular fluid IGF-Ⅱand IGFBP-4 levels may not contribute to different clinical outcomes. |
