| Objective: Discuss the use of antagonist regimen in IVF/ICSI cycles in patients with polycystic ovary syndrome(PCOS)and which is more advantageous.Methods: This study collected patients with polycystic ovary syndrome who underwent IVF/ICSI treatment in the reproductive center of the first affiliated hospital of Guangxi medical university from January 2015 to May2018(including male factors and fallopian tube factors,excluding endometriosis and female genital tract deformity,etc.).The diagnostic criteria for polycystic ovary syndrome refer to Rotterdam standard 2003.Will stimulate ovulation scheme of 378 patients according to different divided into A,B two groups,group A is the GnRH antagonist protocol,group B is the GnRH agonist long protocol,statistics,comparison,respectively A and B two groups of patients with general situation and designed.The Gn in the process of in vitro fertilization and embryo transplantation treatment days,the number of eggs,total dosage of designed.The Gn,pregnancy outcomes and related influence factors.Results:(1)A total of 378 cycles were included as subjects in this study,with the age between(29.97 4.107)years old,the minimum was 20 years old,the maximum was 42 years old,and the infertility years were mainlyconcentrated in 4 years,the minimum was 0.6 years,and the maximum was 16 years.There were 199 primary infertility patients(52.6%)and 179 secondary infertility patients(47.4%).According to the differences of the stimulation schemes,the subjects were divided into two groups,67 antagonist schemes in group A and 311 group leader schemes in group B.There was no significant difference in age,infertility years,infertility type,BMI and other general conditions between the two schemes(P>0.05).(2)By analyzing the fertility factors of patients in group A and group B,it was found that the major combined fertility factors in PCOS patients undergoing IVF/ICSI were pelvic and fallopian tube factors.The combination of pelvic and fallopian tube factors in group A accounted for 59.7%,while that in group B accounted for 64.6%.(3)Comparing the Gn dosage of patients with ovulation induction scheme between group A and group B,it was found that the differences of Gn days,Gn dosage and HCG daily value between the two groups were statistically significant(P<0.05).The Gn days and Gn dosage of group B(long scheme group)were all greater than that of group A(antagonist scheme group),and the HCG daily value of group A was higher than that of group B.However,there was no significant difference in the daily E2 value of HCG and the daily intimal thickness of HCG between the two groups.(4)In this study,the number of eggs obtained in group A was 865,including 486 2PN fertilization,473 2PN cleavage,the number of embryos obtained was 432,182 high-quality embryos,the total number of embryo transplantation was 89,the transplantation rate was70.1%;Group B with egg number at 4724 MEDALS,including 2718 2 pn fertilization,2 pn cleavage 2644,won the embryo number is 2198,976 pieces of high quality embryo,embryo transfer A total of 446,at A rate of 72.3%,but the two groups for egg number,2 pn 2 pn fertilization rate,cleavage rate,embryo transfer,attains the embryo number,high quality embryo number,number,no statistically significant difference were observed in the graft rate(P> 0.05),in the row of two groups of promoting whole embryo freezing rate of group A than group B,but there was no statistically significant difference,the rest all the differences had no statistical significance(P > 0.05);(5)The freezing rate of whole embryo in group A was lower than that in group B,but difference isn't statistically significant,and the other differences were not statistically significant(P>0.05).(6)A group of 47 cases of fresh embryo transplantation,16 cases of whole embryo freezing,20 cases of cycle cancellation,26 cases of biochemical pregnancy,23 cases of clinical pregnancy,4 cases of abortion,9 cases of live birth(including 9 cases of single embryo,0cases of multiple embryos);Group B included 225 cases of fresh transplantation,78 cases of whole embryo freezing,86 cases of cycle canceling,139 cases of biochemical pregnancy,115 cases of clinical pregnancy,12 cases of abortion and 88 cases of live birth(67 cases of single fetus and 21 cases of multiple embryos).The difference in live birth rate between the two groups was statistically significant(P=0.009),and the live birth rate of group B(long program)was higher than that of group A(antagonist group).Ovarian hyperstimulation syndrome(OHSS)rate of group A was lower than that of group B,and the difference was statistically significant(P=0.044).The biochemical pregnancy rate of group A(antagonist regimen group)was lower than that of group B(long regimen group),but difference isn't statistically significant(P>0.05).Other clinical pregnancy rate,abortion rate and other differences were not statistically significant(P > 0.05).Conclution: For PCOS patients,compared with long-term use of GnRH agonists,GnRH antagonist scheme has the advantages of flexible use,shortstimulation time,small Gn dosage and high patient compliance.Meanwhile,it also greatly reduces the occurrence of OHSS,making it a relatively safe choice.However,due to the risk of low pregnancy rate and live birth rate of antagonist regimen,PCOS patients still need to be cautious in the choice of the regimen for promoting excretion. |
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