Comparison Of Controlled Ovarian Stimulation For Infertile Women In Poor Ovarian Response

Poor Ovarian Response(POR)is mainly manifested in the ovary can not fully respond to enough gonadotropins to recruit enough follicles,resulting in oocyte production during the ovulation process to reduce,the cycle cancellation rate increases,the chance of successful pregnancy significantly reduced.It has been reported that POR occurs in 9% to 24% of patients in controlled ovarian stimulation(COS).POR patients who need in vitro fertilization and embryo transfer to assist pregnancy,most of them adopt micro-stimulation or antagonist schemes.In recent years,Kuang et al.have carried out PPOS under the condition of high progesterone,which has become a commonly used progesterone scheme for POR patients because it can effectively inhibit LH peak.ObjectiveThe comparison of the different ovulation-promoting outcomes of in vitro fertilization-embryo transfer in patients with POR and the different ovulation-promoting outcomes after age-stratification for the mild stimulation,antagonist stimulation,and PPOS stimulation to compare the optimal ovarian stimulation protocol for patients with POR.MethodsRetrospective analysis in January 2015 to December 2017 in the first affiliated hospital of zhengzhou university for reproductive medicine center line of the assistant of in vitro fertilization/sperm microinjection one embryo transplantation(in vitro fertilization/intracytoplasmic sperm injection-embryo transfer,IVF/ICSI-ET)the baseline data of all patients,treatment and follow-up ending,Bologna standard screening POR patients,The prescribed standards compliance with article 3 of article 2 can diagnose POR: her age of 40,or have POR or other risk factors,history of low ovarian response(normal ovarian stimulus cancel cycle or for egg number 3 or less),ovarian reserve(ovarian reservetest,ORT)abnormal results(AFC < 5 or AMH < 1.1 ng/m1);or there was no risk factor for the decrease of age or 40 years or other ovarian reserve,and the number of eggs in the normal ovarian stimulation cycle was no more than 3.Inquire and record the treatment regimen and pregnancy outcome of all continuous treatment cycles of POR patients.The first part of the comparison before and after two different methods of clinical and laboratory indexes of stimulate ovulation solution,respectively from micro stimulus plan failed to antagonists or previous antagonists scheme failed to micro stimulus is divided into the first group(n = 238),the previous mild stimulus plan failed to PPOS scheme or previous PPOS failed to mild stimulus for the second group(n = 168),the previous antagonists plan failed to PPOS or PPOS failed to antagonists scheme is divided into 3 groups(n = 175).Three groups of patients were compared within the group of gonadotropin(gonadotropin and designed.the Gn)drug dosage and designed.the Gn days,Human chorionic gonadotropin(Human chorionic gonadotropin,HCG)injection on serum Luteinizing hormone,Luteinizing hormone,LH),Estradiol(Estradiol,E2)levels;A number of eggs,MII rate,2PN fertilization rate,2PN cleavage rate,portable embryo rate,egg utilization,cycle cancellation rate(including cancel take egg rate,not take out the egg rate,rate of embryo transfer,no),and fresh clinical pregnancy rate and thawing cycles,the cumulative pregnancy rate,and the age stratification within the group after comparing the indicators again.In the second part,the patients in the three groups were screened for the first time with micro-stimulation,antagonist and PPOS.Use SPSS 17.0 conduct data analysis and analyze with f test or Fisher exact test.ResultsThis study observed a total of 1162 cycles of progestational pregnancy outcomes in 581 patients with POR.First,comparison between different ovulation induction regimens before and after the same group of patients.1)In the first group,the dosage of antagonists was higher than that of Gn in the micro-stimulus program and the duration of medication was longer,the average number of eggs was higher,the cycle cancellation rate and HCG day serum LH levels were lower(P < 0.05).2)In the second group,the amount of Gn in the follicular phase PPOS scheme was higher than that in the micro-stimulation scheme,the number of days of medication was longer,the egg maturation rate(MII rate)was higher,2PN was higher,the cycle cancellation rate and HCG day serum LH levels were lower(P < 0.05).3)In the third group,the 2PN rate and the egg maturation rate(MII rate)of follicular PPOS was higher than that of antagonist,HCG day serum LH levels was lower(P < 0.05).There was no statistically significant difference in the cumulative clinical pregnancy rate between the two regimens in each group(P > 0.05).Second,the comparison after age stratification.1.The age of ?35 POR patients,The antagonist regimen has a lower cycle cancellation rate(P <0.05)and a higher egg utilization rate than the microstimulation regime(P < 0.05),and there was no statistical difference in other outcome indicators such as cumulative pregnancy rate(P < 0.05).PPOS solutions than antagonist the eggs mature rate(MII)and high 2PN fertilization rate(P < 0.05),but other indicators including 2PN cleavage rate,portable embryo rate and cumulative clinical pregnancy rate of each take eggs cycles were no statistical difference(P > 0.05).Age < 35 patients with POR,antagonists solution compared with the stimulus,the antagonist scheme for 3 cases of clinical pregnancy,micro stimulus didn't get,every other stimulate ovulation outcome indexes had no statistical difference between(P > 0.05);Follicular phase PPOS scheme than the stimulus package 2 pn fertilization rate is high,the low cycle cancellation rate(P < 0.05),follicular phase PPOS scheme for 2 cases of clinical pregnancy,micro stimulus didn't get,other outcome metrics no statistical difference(P > 0.05);Antagonists solutions than the follicular phase of PPOS portable cycle cancellation rate is low(P < 0.05),other outcome indicators no statistical difference(P > 0.05).Third,the three schemes are directly compared.1.PPOS scheme group had the highest FSH value,the lowest AMH level,and the least number of sinus follicle(P < 0.05),indicating that the ovarian function of patients in PPOS scheme group was worse than that of the other two groups.2.Micle stimulus designed the Gn days minimum usage and dosage(P < 0.05)and antagonist scheme attains the eggs,the follicle maturation rate is higher in PPOS regimen(P < 0.05),other outcome metrics including 2PN fertilization rate,2PN,portable embryo rate,cleavage rate eggs utilization,cycle cancellation rate and cumulative clinical pregnancy rate between the three options no statistical difference(P > 0.05).Conclusions1.Micle stimulation,antagonist and follicular PPOS were used in POR patients,and the cumulative clinical pregnancy rate was similar.The cycle cancellation rate of the micro-stimulus program was high,the number of eggs obtained by the antagonist program was high,the egg maturity rate of the follicular PPOS program was high,and the serum LH level of HCG day was low.2.For POR patients aged 35 or older,the egg maturation rate of follicular PPOS was higher.In POR patients younger than 35 years of age,Antagonists solutions than the follicular phase of PPOS portable cycle cancellation rate is low and have a better tendency to obtain clinical pregnancy.