Effect Of Gonadotrophin Starting Time Of GnRH Agonist Long Protocol In Early Follicular Phase On Pregnancy Outcome Of IVF/ICSI-ET In Patients With Different Ovarian Response

Objective:Gonadotropin-releasing hormone agonist was used in COH to down-regulate pituitary function.In order to find a targeted way to start Gn,the relationship between the number of down-regulation days of the GnRH agonist long protocol in early follicular phase and the outcomes of ART in patients with different ovarian response were compared.Methods:A retrospective analysis was conducted in patients undergoing the GnRH agonist long protocol in early follicular phase in the Center of reproductive medicine,the Second Hospital of Hebei Medical University from January 2015 to May 2018.1247 cases were analysed and categorized into three groups according to the number of retrieved oocytes:Group A was ovarian high response group,the number of oocytes retrieved was more than15.Group B was normal ovarian response group,5?the number of oocytes retrieved?15.Group C was ovarian low response group,the number of oocytes retrieved was less than 5.According to the number of days of down-regulation,the patients were categorized for the second time.Group A1,the number of down-regulation days was less than 33 and more than 27,Group A2,32 days<the number of down-regulation days?36 days.Group A3,the number of down-regulation days was more than 36.Group B1,the number of down-regulation days was less than 33,Group B2,32 days<the number of down-regulation days?36 days.Group B3,the number of down-regulation days was more than 36.Group C1,the number of down-regulation days was less than 33,Group C2,32 days<the number of down-regulation days?36 days.Group C3,the number of down-regulation days was more than 36.Descriptive statistics were recorded for the patients'general condition,COH condition,starting day related index,laboratory condition and pregnancy outcome.Result:1.Group by ovarian responseThere was no significant difference in ICSI normal fertilization rate,implantation rate,clinical pregnancy rate,abortion rate and live birth rate among the three groups.The AFC,the total number of follicles on Gn starting day,the number of retrieved oocytes and the number of transferable embryos in group A were significant higher than those in group B,and those in group B were significant higher than those in group C.The age of group B was larger than that of group A?P<0.05?.The level of serum bFSH in group A was lower than that in group B?P<0 05?.Serum bLH in group A was significantly higher than that in group B?P<0 05?.Serum bE₂ in group A was significantly higher than that in group B?P<0 05?.The total amount of Gn in group B was higher than that in group A?P<0.05?.The number of Gn days in group B was significantly higher than that in group C?P<0 05?.The LH in group A was significantly higher than that in group B on the first day of Gn?P<0 05?.The IVF normal fertilization rate in group C was higher than that in group A and group B?P<0.005?.The all embryo cryopreservation in group A was higher than that in group B?P<0.05?.2.High ovarian response groups.There was no significant difference in age,years of sterility,BMI,serum bLH,bE₂,AFC,primary infertility rate,secondary sterility rate,E₂ on the first day of Gn,total number of follicles,number of embryos obtained,all embryo cryoprservation rate,clinical pregnancy rate and live birth rate among the three groups.The bFSH in group A3 was higher than that in group A1?P<005?.The total dosage of Gn and the days of Gn in group A3 were higher than those in group A2?P<0.05?.On the first day of Gn,the FSH in group A3 was lower than that in group A2?P<0 05?.On the first day of Gn,the LH in group A1 was larger than that in group A3?P<0 05?.On the first day of Gn,the endometrium thickness in group A1 was higher than that in group A2?P<0.05?.On the first day of Gn,the diameter of follicles in group A1 was larger than that in group A2,and that in group A2 was larger than that in group A3?P<0.05?.The IVF normal fertilization rate in group A1 was higher than that in group A2and groupA3?P<0.05?.The ICSI normal fertilization rate in group A3 was higher than that in group A1,and that in group A1 was higher than that in group A2?P<0.05?.The number of transplantable embryos in group A1 was higher than that in group A3?P<0.05?.The implantation rate in group A1 was higher than that in group A2?P<0.05?and group A3.3.Normal ovarian response groupsThere was no significant difference in age,years of sterility,bLH,bE₂,AFC,primary infertile rate,secondary infertile rate,total dosage of Gn,Gn days,LH on the first day of Gn,total number of follicles on the first day of Gn,number of embryos obtained,normal ICSI fertilization rate,number of transferable embryos,all embryo cryopreservation rate,implantation rate,clinical pregnancy rate,abortion rate and live birth rate among the three groups?P>0.05?.BMI in group B1 was larger than that in group B3,the difference was statistically significant?P<0.05?.The bFSH in group B3 was larger than that in group B1 and group B2,the difference was statistically significant?P<0.05?.On the first day of Gn,the FSH in group B3 was smaller than in group B1 and group B2,the difference was statistically significant?P<0.05?.On the first day of Gn,the endometrium thickness in group B1 was significantly higher than that in group B3,and the difference was statistically significant?P<0.05?.On the first day of Gn,the diameter of follicles in group B1 was larger than that in group B2,and that in group B2was larger than that in group B3,the difference was statistically significant?P<0.05?.The normal fertilization rate of IVF in group B2 was significantly higher than that in group B1 and group B3?P<0.05?.4.High ovarian response groupsThere was no significant difference in age,years of sterility,BMI,serum bFSH,bLH,bE₂,AFC,COH and data of start of Gn,normal ICSI fertilization rate,number of transplantable embryos,embryo implantation rate,clinical pregnancy rate,abortion rate and live birth rate among the three groups?P>005?.The rate of primary sterility in group C1 was higher than that in group C2?P<0.05?.The rate of secondary sterility in C2 group was higher than that in C1 group?P<0.05?.The number of embryos obtained in C3 group was higher than that in C1 group?P<0.05?.The normal IVF fertilization rate in C2 group was higher than that in C1 group?P<0.05?.Conclusions:1.The time of starting Gn can be determined according to follicular size and hormone level within 28 to 42 days after down regulation,and the number of days of down-regulation itself does not affect the pregnancy outcome.2.Different ovarian responsiveness affected the use of Gn,but did not affect the time of start Gn,and similar pregnancy outcomes could be obtained.3.There are individual differences among the same ovarian response patients,and the days of down-regulation can be different,but the appropriate time of start Gn is basically similar,and similar pregnancy outcomes can be obtained.