The Applications Of Different Protocols Of Controlled Ovarian Hyperstimulation In Patients With Decreased Ovarian Reserve

Objective:Methods: To discuss the value and cost-effectiveness of double stimulations 、 mild ovarian stimulation combined with Gn RH-antagonist 、long protocol in patients with decreased ovarian reserve receiving in vitro fertilization.1.380 patients with decreased ovarian reserve who accepted in vitro fertilization from July 2013 to June 2014 were analyzed retrospectively, 204 were accepted double stimulations and 79 were accepted mild ovarian stimulation combined with Gn RH-antagonist, 97 with long protocol,compared the outcomes and cost of every protocols. Statistical methods using t test and chi-square test.2.39 fresh discarded oocytes were Collected from double stimulations,18 from COH in follicular phase and 21 from COH in luteal phase.Results:1. The basic clinical characters and hormone concentrations in three groups were no difference. The average number of oocytes retrieved、viable embryos、high-quality embryos, consumption and duration of Gn,the serum P level on trigger day in the COH during luteal phase were significantly higher than those during follicular phase,the serum LH level on trigger day is lower than it in follicular phase. The cycle cancellation rate, available rate of oocytes and embryos,cumulative pregnancy rate,abortion rate were similar between the COHs.2. By ultrastructural analysis of using Transmission Electron Microscopy,the Granulosa cells around the oocytes、zona pellucida、perivitelline space、oocyte organelles in double stimulaitons were no abnormal.The mitochondrial density and ratio of normal mitochondria were no difference.3. The number of oocytes retrieved in long protocol is higher than mild stimulation and COH during luteal phase in double stimulation.The viable embryos、high-quality embryos 、fertility rate、cleavage rate were no difference in every groups.The LH level on trigger day were significantlydifferent among the three groups, Group B > group C > group A2.P level of group A2 on trigger day is higher than group B and C,while group B and C were similar.The duration of Gn in group A2 and C were similar,both were higher than group B. The consumption of Gn were group C > group A2 > group B.The available rate of embryos in group C is higher than group A2 and group B, group A2 and B were similar.4. The cost of transvaginal ultrasonography 、hormone test、injection、drugs in COH during luteal phase were significantly higher than COH during follicular phase.Double stimulation have a higher cost in transvaginal ultrasonography and hormone test,but has a lower cost in drugs.The total cost of every groups were long protocol > double stimulations > mild stimulation combined with Gn RH-antagonist.5. The cumulative pregnancy rate in every COH were similar,compared with COH during luteal phase,long protocol have a higher abortion rate.Conclusions:Controlled ovarian hyperstimulation during luteal phase can get better outcomes in patients with decreased ovarian reserve,double stimulations in the same menstrual cycle cut down the treatment time of IVF-ET,is a good choise for patients with decreased ovarian reserve. For patients with decreased ovarian reserve, it is important to individual choice appropriate...