| Objective To explore the endocrime characteristic and the clinical outcomes of CC co-treatment with PPOS based on the freeze-all strategy during controlled ovarian stimulation(COH)in women with polycystic ovarian syndrome(PCOS).Methods 1.A prospective study was conducted including a total of 220 patients with PCOS underwent IVF/ICSI from April 2014 to Novenber 2015 in the Assisted Reproductive Center of Shanghai Ninth People's Hospital.All patients were divided into two groups according to the different protocols.Group A: HMG+MPA(n=110),Group B: HMG+MPA+CC(n=110).The dynamic changes of hormone during ovarian stimulations were analysised to compare the IVF outcomes(including the oocyte retrieved,the matured oocyte,the normal fertility embryos and the valid embryos)and the FET outcomes(including the clinical pregnancy rate and the implantation rate)in the two groups.2.All patients were divided into two sub-groups according to the basal LH level,Group A1: LH>10mIU/mL,Group A2: LH<10mIU/mL,Group B1: LH>10mIU/mL,Group B2: LH<10mIU/mL.The oocyte retrieved,the implantation rate and the clinical pregnancy rate were evaluated to investigate the effect of the serum basal high LH level on the embryo quality in women with PCOS as well the LH level over the stimulation.3.Logistic regression of pregnancy outcome in PCOS was used.Results There were no significant different between Group A and Group B in the general situation.FSH levels increased significantly after HMG administration and kept steady during ovarian stimulation,but the FSH level was higher in the Group B than Group A in mid to late follicular stage.The LH level gradually decreased during ovarian stimulation in Group B,however,in the Group A it showed a slightly rise initially,and then a downward trend,and average LH level values on the trigger day was significantly higher than the Group B(4.49±2.49 vs.2.52±2.09,P<0.05)and no patients experienced premature LH surge.Serum E2 values showed a gradual increase during the ovarian stimulation.The E2 level in the Group B were higher than in the Group A(P<0.05).In the controlled ovarian stimulation cycle,the Group A was characterized by a shortened stimulation duration(9.14±1.3 vs.11.07±1.24,P<0.05)and lower stimulation dose of hMG(1486.34±360.36 IU vs.1930±377.72 IU,P<0.05).The number of oocyte retrieved(12.11±7.25 vs.18.15±9.8,P<0.05),MII oocytes(10.55±6.45 vs.15.94±9.0,P<0.05),the normal fertilized oocytes(8.08±5.35 vs.12.55±7.62,P<0.05)and the cryopreserved embryos(4.69±3.4 vs.6.15±3.74,P<0.05)between the two groups were significantly different.However,the rate of oocyte retrieved(58.88% vs.60.15%),the rate of mature oocytes(87.09% vs.87.78%)and the rate of normal fertilization(76.64% vs.78.78%)showed no significant difference between the two groups,P>0.05.The chemical pregency rate(77.14% vs.66.13%),clinical pregnancy rate(72.86% vs.62.09%),the implantation rate(51.09% vs.45.04%),the miscarriage in the early trigestation(9.8% vs.9.09%)and the ongoing pregnancy rate(62.86% vs.54.8%)were similar in the two groups(P>0.05).The oocyte retrieved in the Group A1 and Group B1 were higher than in the Group A2 and Group B2,while the implantation rate and the clinical pregnancy rate were similar in the two groups(P>0.05).All above confounding variables were not significantly negative effect on the ongoing pregnancy outcome(P>0.05)Conclusion The LH level declined in the PPOS protocol was improved after adding CC,which made the LH level more manageable,meanwhile,no LH surge was found in the two groups.Therefore,the CC co-treatment with PPOS protocol provided a novel controlled ovarian stimulation combined with frozen-all embryo transfer,which could shorten the duration of stimulation and reduce injection pain.The high basal LH level did not show a significant negative clinical impact on implantation rate and pregnancy rate. |
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