| Objective:Aims to compare the treatment outcomes of the different COS protocols by dividing patients undergoing in vitro fertilization(IVF)/Intra cytoplasmic sperm injection(ICSI)into groups according to age and ovarian response estimiated by AMH,and to provide a reference for applicable clinical choice of COS protocols.Methods:An analytic and retrospective cohort study.Patients accepting IVF/ICSI assisted pregnancy treatment from October 2017 to October 2018 in the Department of Reproductive Medicine of the Second Affiliated Hospital of Kunming Medical University,with age<40 years were selected,except uterine cavity deformity and other factors affecting embryo implantation,and 2711 cycles in total.According to different levels of AMH,they were divided into three different study groups:A group with high response(AMH>3.86ng/ml),B group with normal response(1.1≤AMH≤3.86ng/ml),and C group with low Reaction(AMH<1.1ng/mg).Groups A and B used the long follicular phase protocol,the standard long protocol and the antagonist protocol for controlled ovarian stimulantion,and group C used the microstimulation protocol,the low-dose long protocol,and the antagonist protocol for controlled ovarian stimulantion.According to age<35 years old recorded as 1,and age≥35 years old recorded as 2,the A,B,and C components were divided into different subgroups:namely A1 group,A2 group;B1 group,B2 group and C1 group,C2 group.The assisted pregnancy outcomes of patients in the three subgroups using three controlled superovulation protocols were compared and statistically analyzedResults:There were no significant differences(P>0.05)in age,AMH,BMI,and infertility among the 6 subgroups in different COS regimens.1.Group Al:The Gn days,Gn dosage,and number of eggs obtained in the long follicular phase regimen were significantly higher than those in the standard long regimen and antagonist regimen,and the differences were statistically significant(P<0.05).In the treatment outcome,the cumulative pregnancy rate and cumulative live birth rate of the follicular phase long regimen and standard long regimen were significantly higher than those of the antagonist regimen(69.6%VS 63.3%VS 44.4%),(63.5%VS 56.3%VS 34.9%),and the differences were statistically significant(P<0.01),the long follicular phase plan has an increasing trend compared with the standard long plan;The high risk rate of ovarian hyperstimulation syndrome(OHSS)in the standard long plan is significantly higher than the other two plans(36.8%VS 47.1%VS 27.0%),the difference was statistically significant(P<0.01);And the incidence of moderate to severe OHSS was 7.1%for the long-term follicular phase protocol,4.2%for the standard long-term protocol,and 1.6%for the antagonist protocol,and the difference was not statistically significant(P>0.05);The cycle cancellation rate of the standard long regimen was higher than that of the long follicular period regimen(P<0.05).2.Group A2:There were no significant differences(P>0.05)in the amount of Gn,the number of eggs obtained,the cumulative pregnancy rate,and the cumulative live birth rate among the three different regimens;The Gn days of follicular phase long regimen was obviously higher than another two plans(P<0.01),no occurrence of OHSS was observed in the antagonist regimen.3.Group B1:The number of eggs obtained by the antagonist protocol was lower than that of the long follicular phase protocol and the standard long protocol(13.16±6.33 VS 11.33±5.18 VS 9.49±5.92),the difference was statistically significant(P<0.01);the accumulation of antagonists The pregnancy rate was lower than the other two regimens(61.8%VS 56.3%VS 48.3%),and the difference was statistically significant(P<0.05);but the cumulative live birth rate of the three regimens was not statistically different(P>0.05);No OHSS was observed in the antagonists regimen,and the cycle cancellation rate of the antagonist regimen was significantly higher than the other two regimens(P<0.01).4.B2 group:The number of eggs,cumulative pregnancy rate,and cumulative live birth rate of the antagonist program were lower than those of the long follicular phase program and the standard long program(11.48±6.15 VS11.33±5.11 VS 7.88±3.71),(53.5%VS 47.1%VS 38.0%),(42.3%VS 39.0%VS 19.6%),the difference was statistically significant(P<0.01);no OHSS occurred in the three programs.5.Group C1:There were no statistically significant differences(P>0.05)in the embryonic rate,cumulative pregnancy rate,and cumulative live birth rate of the microstimulation regimen,low-dose long regimen,and antagonist regimen;Gn days,Gn dosage,Gn onwards and the number of eggs obtained in the initial stimulation plan were significantly lower than the other two(4.84±2.08VS 10.70 ± 1.90 VS 10.11 ± 2.26),(747.00 ±399.16VS 2968.09±688.05 VS 2954.43 ± 739.45),and(146.00 ±16.26VS 275.27±35.21 VS 290.72±27.08),(2.00 ± 1.37VS 5.06±3.49 VS 4.52±3.06),the difference was statistically significant(P<0.01),and the cycle cancellation rate of the antagonist regime was lower than that of the microstimulation regime(P<0.05),OHSS did not occur in the three scenarios.6.C2 group:There was no significant difference in cumulative pregnancy rate and cumulative live birth rate between microstimulation regimen,low-dose regimen and antagonist regimen(P>0.05);The number of eggs obtained in the microstimulation regimen was significantly lower than other two regimens(1.77±1.46 VS 4.76±3.20 VS 3.63±2.57)had a significant difference(P<0.01),but the embryogenic rate of the low-dose long regimen and antagonist regimen was lower than that of the micro-stimulation regimen(58.8%VS 45.1%VS40.3%),P<0.05.There was no occurrence of OHSS in the three schemes,and the difference in cycle cancellation rate was not statistically significant(P>0.05).Conclusion:1.For patients with high ovarian response and age<35 years,the long follicular phase program can be used as the preferred solution.2.For patients with high ovarian response and age ≥35 years,an antagonist regimen may be preferred considering the time cost and safety.3.For patients with normal ovarian response,regardless of age,the long follicular phase plan or the standard long plan are suitable choices.4.For patients with low ovarian response,microstimulation is a relatively economical option. |
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