Comparison Of GnEH Antagonists And GnRH Agonists In Patients With Expected Ovarian Hyperresponsiveness

Background and purpose:At present,in vitro fertilization embryo transfer(IVF-ET)has become the main method for the treatment of infertility in various reproductive centers.Controlled ovarian hyperstimulation(COH),as a key part of the ovulation promotion program,can effectively improve the success rate of pregnancy assistance and reduce the pain of repeated egg collection in patients,but it also increases the incidence of iatrogenic risk of ovarian hyperstimulation syndrome(OHSS).For patients who are likely to have a high ovarian response,reproductive physicians are paying more and more attention to effectively reducing the occurrence of OHSS and reducing the financial burden of patients without affecting their fertility effect.Since gonadotrophinreleasing hormone agonist(GnRH-a)was applied in clinical practice in 1984,GnRH-a has become the first-line drug for inhibiting premature LH peak in COH.However,GnRH-a scheme often over-inhibits the pituitary ovary axis,prolongs the time of subsequent Gn,increases the dosage of Gn,and requires the use of HCG in trigger,thus increasing the occurrence of ovarian hyperstimulation syndrome.Due to their own special constitution and endocrine,patients with high ovarian response have a narrow threshold range for Gn response,that is,they do not respond or are not sensitive to Gn at a low dose.However,the increase of Gn dose will easily lead to high ovarian response and overreaction,leading to simultaneous development of a large number of follicles and the occurrence of OHSS.This will not only affect the success rate of assisted reproductive technology,but also seriously endanger the health and life of patients.By the end of the 20 th century,the third generation of gonadotropin releasing hormone antagonist(GnRH-ant)without obvious histamine reaction was applied in clinical practice,which not only effectively inhibited endogenous LH peak,but also retained the hypophysis’ reactivity to endogenous GnRH.Moreover,GnRH-a could be selected as trigger drug to avoid the use of HCG,thus greatly reducing the occurrence of OHSS and making the COH regimen more flexible and increasingly used in the COH scheme.The main purpose of this studywas to predict which of the GnRH-ant regimen,luteal phase GnRH-a long regimen and follicular phase GnRH-a ultra-long regimen would benefit more when infertile patients with ovarian hyperresponsiveness were given IVF-ET treatment,so as to provide a basis for predicting the individualized COH program for patients with ovarian hyperresponsiveness.Methods:Were retrospectively analyzed in June 2017 to June 2018 in the first affiliated hospital of nanchang university first line IVF-ET treatment of high predicting ovarian response of 321 cases of patients,with 97 cases with GnRH-ant regimen(GnRH-ant group),luteal phase GnRH-a Long regimen 124 cases(long regimen group)and follicular phase GnRH-a ultra-long regimen in 100 cases(ultra-long regimen group),respectively,statistical comparison of three groups of patients age,infertility age,BMI,AMH,antral follicle count,basal sex hormones and Gn days,Gn dosage,HCG daily hormone,HCG daily intimal thickness,number of eggs obtained,embryo fertilization,pregnancy outcome and OHSS incidence during ivf-et treatment were statistically compared among the three groups and so on.Results(1)There were no significant differences in age,infertility years,BMI,AMH,AFC,and basal sex hormones among the three groups(P>0.05);(2)the number of Gn days and the amount of Gn in GnRH-ant group were lower than that in the ultra-long regimen group,with statistical difference(P<0.05).In the GnRH-ant group,the daily E2 of HCG,the daily LH of HCG and the daily P of HCG were all higher than those in the long regimen group and the ultra-long regimen group(P<0.05).The daily intimal thickness of HCG in the GnRH-ant group was lower than that in the long regimen and ultra-long regimen groups(P<0.05).(3)GnRH-ant group’s average egg number higher than long regimen and ultra-long regimen group,GnRH-ant group2 PN fertilization rate is lower than the long regimen and ultra-long regimen,the above were statistically significant(P < 0.05);The high quality embryo rate in GnRH-ant group was higher than that in the long regimen group(P<0.05).(4)GnRH-ant group of patients with OHSS rates lower than long regimen,withstatistical significant(P < 0.05);(5)the β-HCG positive rate,clinical pregnancy rate and ectopic pregnancy rate of the fresh transplantation period in GnRH-ant group were lower than those in the long regimen group and the ultra-long regimen group,but the clinical pregnancy indexes of the resuscitation transplantation period in the GnRH-ant group were higher than those in the long regimen group and the ultra-long regimen group,with no statistical difference(P>0.05).The planting rate of fresh transplantation cycle in the GnRH-ant group was lower than that in the ultra-long regimen group,with statistical differences(P<0.05).Conclusions:1.It was predicted that the application of GnRH-ant regimen in patients with ovarian hyperresponsiveness was shorter than that of the long regimen and the ultra-long regimen,which could reduce the number of hospital visits and the economic burden of patients;2.It was predicted that GnRH-ant regimen could reduce the incidence of OHSS in patients with ovarian hyperresponsiveness without affecting the average number of eggs obtained and the rate of high-quality embryos;3.GnRH-ant regimen will cause endometrial receptivity damage,reducing the planting rate of patients in the fresh transplantation cycle,and suggest whole-embryo freezing;4.High predicting ovarian response in patients with application of GnRH-ant regimen can have a good pregnancy outcomes in freeze-thaw embryo resuscitation transplantation cycle.