Comparisons Of GnRH Antagonist Protocol And GnRH Agonist Long-term Protocol In Patients With High Ovarian Response

Objective:To stady the differences in controlled ovarian hyperovulation(COH),laboratory indicators,complications in treatment and clinical outcomes between the GnRH antagonist protocol and the GnRH agonist long protocol on patients with high ovarian response in the cycle of IVF/ICSI treatment.To analyze how to have better clinical outcomes while reducing the incidence of moderate to severe ovarian hyperstimulation in patients,and to provide the identifiable ground for the patients with high ovarian response to select proper COH protocols.Methods: 240 patients with high ovarian response using GnRH antagonist protocal and GnRH agonist long-termprotocol were retrospectively analyzed.120 cases used GnRH antagonist protocal and 120 cases used GnRH agonist long-termprotocol.their general information(age,infertility duration,body mass index,basic FSH 、 LH 、 and E level),the controlled ovarian hyperstimulation(Gn dosage,Gn duration,the E2 level on trigger day and the number of oocyte retrieval),the laboratory indicators(2PN rate,cleavage rate,high quality embryo rate),complications(the incidence of the moderate to severe OHSS),and the clinical outcome of the first FET cycle(Biochemical pregnancy rate,clinical pregnancy rate,abortion rate,live birth rate and multiple birth rate)were compared.Results:1.There was no significant difference in the general information between two groups(p>0.05).2.The total dosage and duration of Gn were significantly higher in GnRH agonist long-termprotocol compared to GnRH antagonist protocal(P<0.001).There were no significant difference in the number of retrieved oocytes,the level of serum E2 in HCG day,the portable embryo rate and high quality embryo rate(P > 0.05).There were more large follicles in GnRH agonist long-termprotocol compared to GnRH antagonist protocal.The incidence of moderate and severe OHSS were not statistically significantly different in the two groups.3.There were no sigficant differences in implantation rate,biochemical and clinical pregnancy rate,abortion rate and live birth rate in the two groups(P>0.05).4.Single factor analysis showed that factors related with the number of large follicles,the number of retrieval oocyte and the serum level of E2 on the trigger day,distribution difference had statistically significant in GnRH antagonist protocal(P<0.05),and the other factors were not correlative Statistically(P>0.05);the multivariate Logistic analysis showed that the serum level of E2 on the trigger day,the difference was statistically significant(P<0.05).5.Single factor analysis showed that factors related with the number of large follicles,the number of retrieval oocyte,the insemination and the serum level of E2 on the trigger day,distribution difference had statistically significant in GnRH agonist long-termprotocol(P<0.05),and the other factors were not correlative Statistically(P>0.05);the multivariate Logistic analysis showed that the basal serum level of FSH,the difference was statistically significant(P<0.05).Conclusions:1.For patients with high ovarian response,GnRH antagonist protocal could reduce the dosage and duration of Gn,and this potocol could also relieve the pain of patients and reduce the treatment expense.2.In the treatment of high ovarian response patients who choosing GnRH antagonist protocal,freezing all embryos and thawing selective embryos to transfer,can reduce the incidence of OHSS,at the same time can improve the clinical outcome.3.In this study,GnRH antagonist protocal did not reduce the incidence of moerate to severe OHSS.