Effect Of Two COS Protocols On Outcome Of IVF/ICSI-ET In Patients Of Different Ages Or Different Infertilioty Factors

OBJECTIVE: To investigate the best COS protocol for patients with different ages or different infertility factors by comparing the effect of two COS protocols[gonadotropin-releasing hormone(GnRH)agonist(GnRH-a)long protocol and GnRH antagonist(GnRH-ant)protocol] on outcome of their first in vitro fertilization/ Intracytoplasmic sperm injection-embryo transfer(IVF/ICSI-ET)cycle in patients of different ages or different infertility factorsMethods: A total of 895 patients who underwent their first IVF / ICSIET cycle at the International Peace Maternity & Child Health Hospital from January 2015 to December 2016 were retrospectively evaluated,the patients were grouped according to the COS protocol、the female’s age and infertility factors.Results:For patients included in the study:longer duration of Gn used、higher clinical pregnancy rate and higher ectopic pregnancy rate were observed in GnRH-a long protocol group campared with GnRH-ant protocol group,the difference was statistically significant(P <0.05);For patients under 26-30 years old:higher clinical pregnancy rate and higher endometrial thickness on the day of hCG administration were observed in GnRH-a long protocol group campared with GnRH-ant protocol group,the difference was statistically significant(P <0.05);The effect of age on GnRH-a long protocol was less than its effect on GnRH-ant protocol;This two kinds of COS protocol had no significant effect on the clinical pregnancy rate of different infertility patients;For infertility patients with endometriosis:higher level of LH on the day of HCG administration、higher number of fertilized oocytes 、higher number of cleavage embryos、higher number of transferable embryos oocytes 、higher number of high quality embryos and higher endometrial thickness on the day of hCG administration were observed in GnRH-a long protocol group campared with GnRH-ant protocol group,the difference was statistically significant(P <0.05).Conclusion:Campared with GnRH-a long protocol GnRH-ant protocol can shorten duration of Gn used;For patients under 26-30 years old: GnRHa long protocol is superior to GnRH-ant protocol;For patients of all age groups except 26-30 years old or infertility patients with tubal factors alone :GnRH-a long protocol and GnRH-ant protocol are both effective measures of COS,each with its own advantages and disadvantages;For patients with PCOS,it is still necessary to design multicenter RCTs considering the sample size of this study is small;For patients with endometriosis,GnRH-a long program is more appropriate.