| Objective:To investigate the clinical curative effect of minimal ovarian stimulation protocol in poor ovarian responders and expected poor-responders in the assisted reproductive technology (ART) by comparing different protocols including protocols commencing in luteal phase, follicular period, and the standard long protocol.Method:A total of 199 poor ovarian responders and expected poor-responders were collected in the investigation, including 31 oocyte retrieval cycles of standard long protocol and 37 patients were administrated ovarian stimulation protocol both in the follicular period and luteal phase. There were 276 oocyte retrieval cycles for all the patients,including 123 retrieval cycles initiated in luteal phase and 153 retrieval cycles initiated in follicular period. Those cycles were then divided into three groups. Group A were administrated minimal ovarian stimulation protocol initiated in the luteal phase, Group B were used protocol initiated in the follicular period. Group C were the standard long protocol, Group D were those who got a failure result,and than administrated minimal ovarian stimulation protocol initiated in the luteal phase.Beyond that,37 poor ovarian responders and expected low poor-responders who were administrated the two above stimulation protocols, including 97 oocyte retrieval cycles, were divided into two groups.Group E were administrated minimal ovarian stimulation protocol initiated in the luteal phase, Group F were used protocol initiated in the follicular period.After the ovarian stimulation, the competent embryos were cryopreserved for a later transfer in group C and E.For group D and F,the embryos were transferd or cryopreserved depending on the thickness of the endometrium and the wish of the patients.Results:1. Both group A and group B are succeed in the oocyte retrieval.Up to the finishment of this paper, there were 46 frozen embryo transfer (FET)cycles in group A,9 patients were clinical pregnant, no biochemical abortion happened.28 FET cycles were conducted in group B,8 patients were clinical pregnant,2 biochemical abortion happened. There were no significant differences except BMI in all the parameters (P>0.05) between group A and group B. The dose of HMG,the days of ovarian stimulation,the fertilization rate in group A were significantly higher than those of group B (P<0.05). There were no significant differences in the number of retrieved oocytes, the cleavage rate,the high-quality embryo rate,the pregnancy rate (including clinical pregnant and biochemical pregnant of FET cycle) (P>0.05), but it is higher for the high-quality embryo rate of group A to group B.2. There were no significant differences in the age,years of infertility,AFC, BMI,the basal hormone levels (FSH、LH、E2),FSH/LH between group C and group D.The cycle cancellation rate of group D is lower than group C, and the fertilization rate in group D were significantly higher than those in group C (P<0.05), though there were no significant differences between the two groups, the cleavage rate, the high-quality embryo rate,and the pregnancy rate had the trend of increasing of group D to group C (P>0.05).3. Both group E and group F are succeed in the oocyte retrieval.Up to the finishment of this paper, there were 14 FET cycles in group E,2 patients were clinical pregnant,13 FET cycles were conducted in group F,8 patients were clinical pregnant, no biochemical abortion happened in the two groups. The dose of HMG,the days of ovarian stimulation,the fertilization rate in group E were significantly higher than those of group F (P<0.05). There were no significant differences in the age,years of infertility,AFC, BMI,the basal hormone levels (FSH、LH、E2),FSH/LH,the number of retrieved oocytes, the fertilization rate, the cleavage rate,the high-quality embryo rate,the FET pregnancy rate (P>0.05),but the high-quality embryo rate and the pregnancy rate of group E are higher than those of group F.Conclusion:1. Luteal-phase ovarian stimulation protocol and Luteal-phase ovarian stimulation protocol are both feasible for assisted reproduction treatment in patients with poor ovarian responders and and the expected poor-responders.2.Luteal-phase ovarian stimulation can get better fertilization rate,embryo quality and then get pregnant.3.The cycle cancellation rate of the Luteal-phase ovarian stimulation protocol is lower than the standard long protocol.4.Luteal-phase ovarian stimulation can improve the ratio of high quality embryo and clinical outcome of the poor ovarian responders and expected poor-responders. |
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