| Part Ⅰ Occurrence and reasons for suboptimal ovarian response in infertile women undergoing GnRH antagonist protocol.[Objective]To investigate the occurrence and possible reasons for suboptimal ovarian response in infertile women undergoing GnRH antagonist protocol by analyzing their clinical characteristics.[Materials&Methods]A retrospective study of infertile women who underwent IVF/ICSI treatment by GnRH antagonist protocol was conducted between January 2014 and September 2016 in Center for Reproductive Medicine,Department of Gynecology and Obstetrics,Nanfang Hospital,Southern Medical University.According to the duration day of Gn,cycles were divided into two groups:suboptimal ovarian response group(the duration day of Gn>14,n=37)and controlled group(the duration day of Gn<14,n=741).Patients diagnosed as Polycystic ovary(PCO)or Polycystic ovary syndrome(PCOS)made up group A(n=308),while others with normal ovarian reserve composed group B(n=470).Then cycles were divided into four groups:group A1(PCO/PCOS but suboptimal response,n=31),group A2(PCO/PCOS-controlled group,n=277),group B1(normal ovarian reserve but suboptimal response,n=6),group B2(normal ovarian reserve-controlled group,n=464),on the basis of the duration day of Gn.Compare the basal characteristics and treatment parameters between suboptimal ovarian response group and its controlled group,group A1 and group A2,group B1 and group B2 separately.SPSS 20.0 statistical software was used for statistical analysis.[Results]1.The incidence of suboptimal ovarian response in GnRH antagonist protocol was 4.8%(37/778),lower than that(10～15%)in GnRH-a long protocol.2.The body weight,BMI,antral follicle count(AFC),basal LH,rate of PCO/PCOS,initial dose of Gn,initial Gn dose per kilogram of body weight had significant difference in suboptimal ovarian response group and its controlled group(P<0.05).Multivariate logistic regression analysis showed that being PCO/PCOS was an independent risk factor for suboptimal ovarian response(OR=4.166,P<0.05)in GnRH antagonist protocol.3.The body weight,BMI and dose of Gn in group A1 were significantly higher than that in group A2(P<0.05).There also had significant difference between group B1 and group B2 in AFC,initial dose of Gn,initial Gn dose per kilogram of body weight and dose of Gn(P<0.05).[Conclusion]The incidence of suboptimal ovarian response in GnRH antagonist protocol was lower than that in GnRH-a long protocol(4.8%VS 10-15%).Patients diagnosed as PCO or PCOS were inclined to become suboptimal ovarian response in GnRH antagonist protocol.Overweight or obesity might be the reason for suboptimal ovarian response in PCO/PCOS patients,while the insufficiency of initial dose of Gn might lead to suboptimal response in normal ovarian reserve women.Part Ⅱ Management and clinical outcomes for suboptimal ovarian response in PCO/PCOS women undergoing GnRH antagonist protocol.[Objective]To investigate the management and clinical outcomes for suboptimal ovarian response in infertile women diagnosed as PCO or PCOS undergoing GnRH antagonist protocol by analyzing related characteristics.[Materials&Methods]Patients were same with Part I.We chose group A(n=308)as this part’s object.Cycles were divided into two groups:31 cycles with suboptimal ovarian response in group A1(n=31)and 277 cycles as controlled-group called group A2(n=277),same with Part I.Compare the treatment parameters and clinical outcomes between group A1 and group A2.According to the management,group A1 was also divided into three subgroups:group X(increasing dose of FSH,n=13),group Y(increasing dose of FSH and adding LH,n=13),group Z(increasing dose of FSH,adding LH and stopping GnRH-ant temporarily,n=5).Clinical outcomes such as number of oocytes retrieved,number of good-quality embryos,rate of mature metaphase Ⅱ(MII)oocytes,normal fertilization proportion,cleavage rate,rate of good-quality embryos were evaluated among the three subgroups.We used SPSS 20.0 statistical software to analyze the statistic.[Results]1.The time of GnRH-ant addition,the duration day of GnRH-ant,number of follicles≥10mm,≥12mm,≥14mm and level of E2 on the day of adding GnRH-ant had significant difference in group A1 compared with group A2(P<0.05).2.Parameters of clinical outcomes such as number of oocytes retrieved,number of good-quality embryos,rate of MII oocytes,normal fertilization proportion,cleavage rate,rate of good-quality embryos,implantation rate,clinical pregnancy rate and cumulative pregnancy rate had no significant difference between group A1 and group A2(P>0.05).3.There had significant difference in the dose of Gn among the three subgroups(group X<group Y<group Z,P<0.05).Besides,rate of MII oocytes and normal fertilization proportion also had significant difference among the three subgroups(group Z<group X<group Y,P<0.05).[Conclusion]Treatment of increasing FSH dosage,adding LH,stopping GnRH-ant temporarily might help to improve the clinical outcomes and avoid poor ovarian response in infertile women diagnosed as PCO or PCOS with suboptimal ovarian response,which might not affect the pregnancy outcomes when undergoing GnRH antagonist protocol. |
