Investigation About The Value Of Modified Super-long Protocol In Patients With Diminished Ovarian Reserve In Vitro Fertilization And Embryo Transfer

OBJECTIVES:1.Relatively modified super-long down regulation protocol, long protocol, antagonist protocol for the advanced age of diminished ovarian reserve(DOR) patients applications.2.Investigation about the modified super-long down regulation protocol after the first time in vitro fertilization-embryo transfer treatment failure DOR patients. METHODS:1.Retrospective analysis of the first cycle of in vitro fertilization(IVF) or intracytoplasmic sperm injection(ICSI) assisted reproductive treatment of 146 cases of clinical data in DOR patients and age≥35 years. According to ovulation induction into modified super-long down regulation protocol group(A, n=49), long protocol group(group B, n=65) and antagonists protocol group(group C, n=32), three groups of patients with treatment and the outcome of the case.2.Retrospective analysis 29 cases in DOR patients data of IVF, where the first cycle use long protocol without pregnancy, the second cycle use modified super-long down regulation protocol, self-control treatment outcomes in two cycles. RESULTS:1.Three groups of patients with modified super-long down regulation protocol, long protocol, antagonist protocol were group A>B>C in Gn dosage, the difference was statistically significant(P<0.05); number of days in Gn group A than that group B, group C, and the difference was statistically significance(P<0.05); while HCG injection day serum E2 levels and number of oocytes in group A and group B were higher than group C, the difference was statistically significant(P<0.05); group A of high-quality embryos was significantly higher than group C, and the difference was statistically significant(P<0.05); group A of transplantation cancellation rate is lower than group B and group C, the difference was statistically significant(P <0.05); three groups of the number of frozen embryos, implanting rate and clinical pregnancy rate were group A> B> C, the difference was not statistically significant(P>0.05).2.The second cycle of HCG injection day serum LH,E2,P levels and endometrial thickness, number of oocytes, number of embryos transferred compair with the first cycle showed no significant difference(P>0.05), high-quality embryos of the second cycle higher than the first cycle, but the difference was not statistically significant(P> 0.05); dosage of Gn, number of days in Gn, the number of frozen embryos in second cycle greater than the first cycle, the difference was statistically significant(P<0.05), the second cycle was finally modified super-long down regulation protocol gained 30.4% clinical pregnancy rate. CONCLUSIONS:1. Modified super-long down regulation protocol and long protocol compared to antagonist protocol improvement group, Gn dosage is big, but HCG injection day serum E2 levels and number of oocytes increased significantly.2. Modified super-long down regulation protocol group than the other two groups tended to increase the number of frozen embryos,the implanting rate and clinical pregnancy rate.3. Modified super-long down regulation protocol without increasing their OHSS risks and economic pressure on the premise can improve the quality embryo, reduce fresh cycle cancellation rate,for advanced age of poor ovarian reserve underwent IVF/ICSI, is an alternative treatment.4.Modified super-long down regulation protocol can obtain long down regulationg time,coupled with the use of HMG ovarian hyperstimulation, can appropriate to add LH, increase endometrial receptivity, the number of frozen embryos also increase and improve patient cumulative pregnancy rate, for DOR underwent IVF assisted reproduction have failed for the first time, modified super-long protocol is an attempt to be adopted for the second time.