Analysis Of The Ovarian Hyper-Response Related Factors In Controlled Ovarian Hyperstimulation Treatment

Objective:Through observing the individual indicators of the controlled ovarian hyperstimulation patients who had been assisted by IVF-ET or ICSI and comparing whether the differences between these indicators are statistically significant, we can confirm which factors have essential effects on ovarian response. Then according to the analysis of these essential factors we can work out an optimal clinical method to reduce the negative effects and increase the pregnancy rate.Methods:A database was analyzed retrospectively concerning GnRH-agonist long protocol in vitro fertilization-embryo transfer (IVF) or intracytoplasmic sperm injection (ICSI) COH cycles from January 2007 to October 2009 at the reproductive medical center of the Third Affiliated Hospital of Guangxi Medical University. Excluding the patients with the disease which will definitly affect the ovarian response. There are 183 cycles, including 96 cycles of high-reactive group and 87 cycles of the control group. Basic prediction index:age, antral follicle count (AFC),basic ovarian maximum cross-sectional area, body mass index (BMI), basic sexual hormone levels (FSH, LH, FSH/LH, E2, PROG, TESTO, PRL);In cycle prediction index:down regulation sexual hormone levels (FSH, LH, E2, PROG), HCG day E2 level,how many Gn was used from beginning,the days between down regulation and using Gn, how long is the controled ovarian hyperstimulation lasts and the total count of Gn. First usingχ2 test to analyse the etiologic composition of the two groups. Second using t test to compare the related factors of the two groups Third usingχ2 test to compare the pregnancy outcome of the two groups. Finally using logistics regression to screen out risk factors.Results:1.Etiological analysis:All the etiologics have no statistically significant diffrence(P>0.05).2.Basic prediction index:comparing the two groups AFC(P=0.028,<0.05) and basic FSH level(P=0.020,<0.05) have statistically significant diffrence. Experimental group has more AFC and lower basic FSH level. Basic ovarian maximum cross-sectional area, BMI, basic (LH, FSH/LH, E2, PROG, TESTO, PRL) level do not have diffrence from the control group(P>0.05).3.In cycle prediction index:HCG day E2level has statistically significant diffrence(P=0.000,<0.05).The value of HCG day E2 level in experimental group is higher than control group's. Down regulationed FSH, LH,E2 and P's levels, Gn beginning counts, the days between down regulation and using Gn, hyperstimulation days and total Gn counts have no signifcant diffrence.4. Comparing the pregnancy rate (including fresh embryo transfer and frozen embryo transfer), excellent embryo rate, frozen implantation rate and OHSS occurred rate we find that ovarian hyper-response patients can receive more frozen embryo(P=0.000,<0.05), but the risk of OHSS will be increased (P=0.006,<0.05) and the pregnancy outcome can't be improved,either.5.Logistics regression analysis showed that:Basic FSH is a protective factor. AFC and down regulationed LH level are risk factors. The ovarian hyper-response rate of the patient who's Gn starting by 150iu and 225iu per day are 7.399 and 6.693 times as high as the the one starting by75iu per day.And there is no diffrence between Gn starting by 150iu and 225iu per day.Conclusion:1.AFC and down regulationed LH are risk factors of ovarian hyper-response, while basic FSH level is a protective factor of ovarian hyper-response.2.The ovarian hyper-response rate of the patient who's Gn starting by 150iu and 225iu per day is 7.399 and 6.693 times as high as the the one starting by 75iu per day.And there is no diffrence between Gn starting by 150iu and 225iu per day. So Gn starting by 75iu per day will reduce the risk of ovarian hyper response.3.Ovarian hyper response patients'excellent embryo rate is equal to the normal response patients'. Although their frozen embryo rates are higher than the normal response patients', their pregnancy outcome can't be improved and their OHSS risk will increase.Thus, for the patients with either of the character more AFC, lower basic FSH level and higher down regulationed LH level their Gn dose should be begun with 75iu per day to avoid ovarian hyper-response and achieve ideal pregnancy outcome.