Effects Of Different Gonadotropins On Clinical Pregnancy Outcomes In Elderly Patients

Objective The effects of three different gonadotropins with HMG,uFSH and rFSH on the clinical outcome of IVF/ICSI-ET in patients?35 years old were compared.Methods A retrospective analysis of medical records of elderly patients??35?who underwent IVF/ICSI-ET antagonist treatment in General Hospital of Ningxia Medical University and Yinchuan Maternal and Child Health Hospital Reproductive Medicine Center from May 2013 to May 2019.First,according to ovarian stimulation The different ovulation-promoting drugs used in the cycle are divided into:HMG group group A,n=199),uFSH group?group B,n=198?,rFSH group?group C,n=103?,comparison The general conditions,laboratory-related indicators,and clinical pregnancy outcomes of patients in each group.According to the number of oocytes obtained,it was further divided into normal ovarian response group?the number of oocytes obtained>5?and low ovarian response group?the number of oocytes obtained?5?for comparison.The number of obtained oocytes>5group:HMG group?n=115?,uFSH group?n=144?,rFSH group?n=86?,number of oocytes?5:HMG group?n=84?,uFSH group?n=54?,rFSH Group?n=17?;followed by age:35?age?37 group?n=154?,38?age?40 group?n=178?,and age>40 group?n=168?.The general conditions,laboratory-related indicators,and clinical pregnancy outcomes of patients in each group were compared.The general situation includes the woman's age,infertility years,type of infertility?primary or secondary?,infertility factors?fallopian tube factor,ovarian factor,endometrial factor,male factor,unknown cause?,body mass index?BMI?,foundation FSH,LH,E2 levels,basal sinus follicular count?AFC?.Laboratory and clinical indicators include total gonadotropin?Gn?medication,Gn stimulation days,hCG daily serum E₂,LH,P level,hCG endometrial?EM?thickness,number of oocytes obtained,MII oocytes rate,2PN fertilization rate,High-quality embryos,average number of transferred embryos,frozen embryos,implantation rate,clinical pregnancy rate,live birth rate,cumulative live birth rate,cumulative pregnancy rate,non-transplantable embryo rate,incidence of ovarian hyperstimulation syndrome?OHSS?,The total cost of treatment,etc.Results?1?In general comparison,the AFC values of the three groups of patients are different and have statistical differences.The rFSH group is significantly higher than the other two groups?P<0.05?,but the clinical pregnancy rate,implantation rate,and live birth rate of the three groups are all There was no statistical difference?P>0.05?.The Gn dosage and Gn stimulation days of the rFSH group were significantly lower than those of the HMG group and uFSH group?2267.6±746.5 vs 2563.8±1088.7 vs 2529.4±823.8,P<0.05;9.3±1.7 vs9.9±2.5 vs 10.0±2.3,P<0.01?,the number of oocytes obtained,the number of MII oocytes,the number of follicles?17mm on hCG day,the number of high-quality embryos,and the E₂ level on hCG day were significantly higher than those in HMG group.The differences were statistically significant?P<0.05?.).The AFC value of uFSH group was also significantly lower than that of rFSH group?P<0.05?,but there was no statistical difference in the number of oocytes obtained,the number of MII oocytes,and the number of high-quality embryos in the two groups,and the 2PN zygote rate,The cleavage rate and the number of frozen embryos were significantly higher than those of the other two groups?P<0.05?.The cost per live birth in the HMG group was significantly lower than the uFSH and rFSH groups?434.2$vs2331.1$vs 3284.5$?.?2?Among patients with normal ovarian response?number of oocytes obtained>5?,the number of oocytes obtained,the number of MII oocytes,and the number of high-quality embryos in the rFSH group were significantly higher than those in the other two groups?P>0.05?,but the pregnancy rate and implantation among the three groups were significantly higher.There was no statistically significant difference in the rate and live birth rate;in the patients with low ovarian response?the number of oocytes obtained?5?,the number of oocytes obtained by the rFSH and uFSH groups was greater than that of the HMG group,but the clinical pregnancy rate and implantation rate of the uFSH group were significant.Higher than the rFSH group and HMG group?31.5%vs 17.9%vs 5.9%,P<0.05;22.7%vs 11.3%vs 4.8%,P<0.05?;?3?The three groups of patients were stratified by age,at35?age Among patients?37 years old,the AFC,the number of oocytes retrieved,the number of MII oocytes,and the number of high-quality embryos in the rFSH group were significantly higher than those in the other two groups?P<0.05?.The IVF fertilization rate in the uFSH group was the highest with statistical differences?P<0.05?,and there was no statistical difference in clinical pregnancy rates among the three groups?P>0.05?;among patients aged?38?40 years,the AFC,the number of oocytes obtained,and the number of MII oocytes were significantly higher in the rFSH group and the uFSH group.In the HMG group,there was no statistical difference in the clinical pregnancy rate among the three groups?P>0.05?;among patients>40 years of age,there was no difference in the AFC of the three groups,but the uFSH group had the largest number of oocytes,planting rate and live birth HMG was significantly higher than HMG and rFSH group?15.4%vs 4.4%vs 13.0%,P<0.05;12.9%vs1.3%vs 6.7%,P<0.05?.Conclusion 1.For women with 35-39 years old,there are no significant differences in the clinical pregnancy outcomes of the three gonadotrophins,but HMG is more cost-effective.2.For older infertile patients>40 years of age and with low ovarian response,uFSH can effectively improve implantation rate and live birth rate.