The Analysis About The Timing Of Start Of Controlled Ovarian Hyperstimulation And The Outcome Of Ivf-et After Long Protocol Down-regulation

Objective To evaluate the impact of timing of start of controlled ovarian hyperstimulation on the outcome of IVF-ET after long protocol down-regulation.Methods 845 in vitro fertilization (IVF)/ intracytoplasmic sperm injection (ICSI)-embryo transfer (ET) cycles with long protocol down-regulation performed in Reproductive Medicine Center of Tongji Hospital from May 2006 to May 2007 were analyzed retrospectively. First of all , the clinical outcome is compared between the patients with pituitary over suppression and the ones without it,after the use of GnRH-a routinely starting COH on day 3 of the menstrual cycly. Then, compare the outcomes of starting COH on day 3~5 (group1)and starting it on day 6~8(group2),in patients with pituitary over suppression and the ones without it ,respectively.Result In the patients conventionally starting COH on the day3,the amount of Gn and the period of ovarian stimulation were higher in the patients with over suppression than the ones without it . While the number of the retrieved oocytes , good quality embryos, embryo implantation rate and the ongoing pregnancy rate were lower in the over suppression patients. Between the patients with over suppression and the ones without it , the same result was calculated: The number of >14mm follicles and retrieved oocytes in group2 were significantly higher than in group 1(p<0.05).While the number of Gonadotropin ampoules and the period for ovarian stimulation were lower in group 2 than in group 1(p<0.05). And in group 2, serum E2 and LH lever were higher on the day of injecting HCG (p<0.05). But as for the clinical result, no significant difference is shown between the two groups on the number of good quality embryos, clinical pregnancy rate and ongoing pregnancy rate (P>0.05).Conclusion After down regulation in long protocol, some patients get pituitary oversuppression ,which can impact on their clinical outcome. Ovarian stimulation period and ampoules of Gn were decreased by appropriate delaying of starting time of COH, meanwhile the numbers of >14mm follicles and retrieved oocytes were increased. However, the number of good quality embryos, clinical pregnancy rate and ongoing pregnancy rate had no significant difference.