Analysis Of Different Endometrial Preparation Protocols For The Elder Infertile Patients In The FET Cycles

Objective By comparing the frozen thawed embryo transfer(FET)effects on different infertile elderly women,with the three kind of endometrial preparation schemes retrospectively: that is,with the down regulation of combined with estrogen and progesterone(Down regulation + E-P scheme),hormone replacement cycle(E-P)and natural cycle for endometrial preparation before FET,to investigate the moderating effect of gonadotropin releasing hormone agonist(Gn RHa)in the regulation of controlled ovarian hyperstimulation(COH);to observe its influences to the endometrial receptivity,and the synchronization of the development of endometrium and ovarian follicle;to explore the appropriate FET preparation for the treatment of refractory senile infertile women.Object and Methods A total of 143 cycles elder women(143 patients)ageing 38~43years old,who were seeking for frozen-thawed embryo transfer(FET)during March 2014 and January 2016 at Reproductive Center in Linyi Women and Children Health Care Hospital,Shandong,China,were investigated in this study.According to the clinical situation and protocols taken for endometrial preparation,143 patients were classified into three groups: Patients who went through 2 times or more transfer failure and used Gn RHa combined with hormone replacement were collected in down-regulated group,Group I(n=50).Those who seek IVF due to the simple tubal factor or the male factor and have abnormal ovulation,were given hormone replacement,were taken as the artificial cycle group,Group II(n=45).Those who seek IVF due to the simple tubal factor or the man's factors and have normal ovulation,were as the natural cycle group,Group III(n=48).Using Transvaginal color Doppler ultrasonography,the thickness and sonographic appearance of endometrium on the progesterone day for every patient in three groups were detected,ultrasound monitoring parameters ratings were underwent by related indicators of econometric monitoring,to evaluate the endometrial receptivity.Serum level of hormones such as estradiol(E2),luteinizing hormone(LH),progesterone(P)and follicle stimulating hormone(FSH)on the menstrual cycle second day,the progesterone day and the transfer day were respectively detected.The differences in endometrial ultrasound monitoring parameters ratings,serum level of hormones and clinical outcomes were analyzed statistically and compared among the groups.Results Transvaginal color Doppler ultrasound examination showed that there was no significant difference with endometrial receptivity index among three groups of infertile patients.Serum hormone levels showed no significant differences among three groups in the serum E2,P,LH,FSH levels on the second day of the menstrual cycle(P>0.05).On the progesterone day and the transplant day,serum LH,FSH level in Group I was significantly lower than Group II and III(P <0.05),while serum E2,P levels showed no significant differences among the three groups(P>0.05).The comparison of pregnancy outcomes displayed no significant difference among the three groups in embryo implantation rate,clinical pregnancy rate,ectopic pregnancy rate and early abortion rate(P >0.05).Conclusion For the implementation of frozen thawed embryo transfer,different endometrial preparation program should be aimed at different conditions of elderly infertility patients.To elderly infertile patients with repeated embryo transfer failure,Down regulation + E-P scheme for endometrial preparation treatment before FET can improve the endometrial receptivity,improve the outcome of pregnancy.