Clinical Application Of Gonadotropin-releasing Hormone Antagonist In Chinese Women Undergoing Controlled Ovarian Hyperstimulation For IVF-ET

BackgroundGnRH analogues have been used to prevent the midcycle luteinizing hormone (LH) surge that results from multiple follicular development. At present GnRH agonists protocol is identified to be the optimal protocol in a general population.But several undesirable effects inherent to GnRH agonist medication have been taken for granted, such as the postponement of exogenous stimulation and the need for increased amounts of exogenous gonadotropins due to ongoing suppression of endogenous gonadotropins;the incidental formation of ovarian cysts due to the flare.Antagonist protocol avoids the adverse effects of agonists and is significantly associated with a lower duration of treatment and total administered doses of Gn,but it's apparently often not employed as a first line treatment and is often utilized in cycles with an unfavourable a priori prognosis.Much more studys are required to firmly establish the effectiveness and safety of this treatment modality in everyday clinical IVF practice.ObjectivesTo investigate the application of gonadotrophin-releasing hormone Antagonist GnRHA)in patients undergoing ovarian stimulation. And to find an economic,effective, secure and Individual method to the different patients in the treatment of controlled ovarian hyperstimulation.Materials and Methods(1)81 GnRHA alone ovarian stimulation protocols(no pretreated) were retrospectively studied and 81 cycles were divided into two groups according to the age,age<35years(n=54),age≥35 (n=27).Comparison between 261 GnRHa long protocols was carried out.(2) 113 GnRHA cycles were pretreated with OCPs,125 GnRHA cycles were pretreated with short-acting GnRHa in midluteal phase and 81 cycles weren't pretreated. An analysis of the anamnestic data of these patients was carried out for the assessment of the ovulation promoting effect of different treatments and their influence on the IVF-ET outcome. (3) 319 cycles were divided into four groups according to the percentile E2 on the day of hCG administration. Group A consisted of norm al responders defined as women with oestradiol concentrations between the 25th and 75th percentiles(872.50-2363.50 pg/ml,116 cycles), group B consisted of moderately high responders, defined as women with oestradiol concentrations between the 75th and 90th percentile(2363.50-2945.11 pg/ml,47cycles). Group C was set the cut off concentration for hyper-responders as the 90th percentile and above(≥2945.11 pg/ml,31 cycles). The pregnancy out comes among four groups were analyzed with ANVOA test.Results(1) The mean duration of infertility, basal FSH,the estradiol level on hCG day were similar between groups. The total implantation rate and clinical pregnancy rate of GnRHA protocols was no significantly lower than GnRHa long protocols'.(2)The age of patients was significant older in of OCPs pretreatment group,and no significant differences were noted in the number of oocytes retrieved, number of MII oocytes.fertilization rate in three groups.In GnRHa pretreatment group,the total gonadotropin dose used, the duration of stimulation and the rate of high quality embryos were significantly higher than other two group.The endometrial width, implantation rate and clinical pregnancy rate was significantly lower in OCPs pretreatment group, but the implantation rate and clinical pregnancy rate of non-pretreat GnRHA protocols and GnRHa pretreatment GnRHA protocols was similar with GnRHa long protocols'(P>0.05).(3) For low response group, the number of oocytes retrieved, number of MII oocytes were significantly less than normal response group.,but there was no significantly differences in implantation rate and clinical pregnancy rate.For high responds group, top quality embryos were significantly more than normal response group,but the implantation rate and clinical pregnancy rate of high response group was lower (P>0.05).ConclusionsFor the older women and the potential poor responders, GnRH-ant protocol can retrieve a good number of oocytes, reduce the dosage of gonadotropin and shorten the duration of stimulation. For the young women, with acceptable clinical pregnancy rate,the cost and the compliance of GnRH-ant protocol was better than GnRHa flare-up protocol.The clinical pregnancy rate of non-pretreat group and GnRHa pretreatment group was improved.It's similar with GnRHa long protocol's.There was no significantly differences among normal responders,low responders and high responders in implantation rate and clinical pregnancy rate in GnRHA protocols.