| Objective:To systematically evaluate the clinical effects of different controlled ovarian stimulation on IVF-ET in elderly patients with Poor ovarian response.Methods:The databases were comprehensively searched by computer,including Chinese databases such as CBM,CNKI,VIP,Wanfang,etc.and English databases such as Pub Med,Cochrane Library,EMbase,etc.from the time of database establishment until January 2019.Two evaluators independently performed literature screening,data extraction and quality assessment based on inclusion and exclusion criteria.Meta-analysis was performed using Rev Man5.3 statistical software provided by the Cochrane Collaboration Network.Results:9 articles were finalized after strict screening,including 1982 POR patients.Meta-analysis results showed that the controlled ovarian hyperstimulation protocol(Gn RH-a long cycle,Gn RH-a short cycle,antagonist cycle)compared with the minimail stimulation protocol,the cycle clinical pregnancy rate was[OR=1.24,95%CI(0.86,1.80),P=0.25],[OR=1.46,95%CI(0.92,2.31),P=0.11],[OR=0.88,95%CI(0.29,2.67),P=0.82];the abortion rate was[OR=0.65,95%,respectively.CI(0.29,1.48),P=0.31],[OR=1.72,95%CI(0.37,8.04),P=0.49],[OR=0.72,95%CI(0.27,1.98),P=0.53]The fertilization rates were[OR=0.88,95%CI(0.75,1.03)P=0.10],[OR=1.00,95%CI(0.78,1.28)P=0.99],[There was no significant difference in OR=0.89,95%CI(0.69 1.15)P=0.39].The controlled ovarian hyperstimulation protocol(Gn RH-a long cycle,Gn RH-a short cycle,antagonist cycle)compared with the minimail stimulation protocol,the total amount of Gn used was[SMD=2.4,95%CI(1.76,3.05)P=0.0001],[SMD=2.29,95%CI(1.36,3.23)P=0.00001],[SMD=1.90,95%CI(0.71,3.09)P=0.02];Gn usage days are[SMD=1.42,95%CI(0.69,2.15)P=0.0001],[SMD=1.21,95%CI(1.02,1.39)P=0.00001];The number of oocytes obtained was[SMD=0.75,95%CI(0.61,0.89)P=0.00001],[SMD=1.02,95%CI(0.21,1.83)P=0.01],[SMD=0.61,95%CI(0.39,0.83)P=0.0001],the total amount of Gn used,the number of Gn days,and The number of oocytes obtained in The controlled ovarian hyperstimulation protocol were larger than those in the minimail stimulation protocol,and there was a significant difference.The controlled ovarian hyperstimulation protocol(Gn RH-a long cycle,Gn RH-a short cycle,antagonist cycle)compared with the minimail stimulation protocol,the HCG day E2values were[SMD=0.56,95%CI(0.42,0.70)P=0.00001],[SMD=0.55,95%CI(-0.05,1.14)P=0.07],[SMD=1.08,95%CI(0.49,1.66)P=0.00001],controlled ovarian hyperstimulation protocol The HCG day E2value of the group was greater than that of the minimail stimulation protocol.The Gn RH-a long cycle and the antagonist cycle were significantly different from the minimail stimulation protocol.There was no significant difference between the Gn RH-a short cycle and the minimail stimulation cycle.The controlled ovarian hyperstimulation protocol(Gn RH-a long cycle,Gn RH-a short cycle,antagonist cycle)compared with the minimail stimulation protocol,the cancellation rate of the transplantation cycle were[OR=0.33,95%CI(0.13,0.83),P=0.02],[OR=0.56,95%CI(0.40,0.80),P=0.001],[OR=0.32,95%CI(0.18,0.57),P=0.00001],the elimination rate of the transplant cycle in The controlled ovarian hyperstimulation protocol was lower than that in the minimail stimulation protocol There are significant differences.The controlled ovarian hyperstimulation protocol(Gn RH-a long cycle,Gn RH-a short cycle,antagonist cycle)compared with the minimail stimulation protocol,the number of transplanted embryos was[SMD=0.44,95%CI(0.09,0.58)P=0.00001],[SMD=0.27,95%CI(0.08,0.46)P=0.005],[SMD=0.07,95%CI(-0.87,1.02)P=0.88],Gn RH-a long cycle,Gn RH-a short cycle transplantation There were significant differences in the number of embryos compared with the minimail stimulation protocol;there was no significant difference between the antagonist cycle and the minimail stimulation protocol.Conclusion:For reports of patients with poor ovarian response,The number of oocytes obtained by The controlled ovarian hyperstimulation protocol was higher than that of the minimail stimulation protocol,the cancellation rate of the transplantation cycle was lower than that of the minimail stimulation protocol,and the clinical pregnancy rate was not significantly different from the minimail stimulation protocol.Objective : To analyze the clinical effects of different ovulation induction programs in IVF-ET in elderly patients with POR.Methods:A retrospective analysis of POR patients who underwent IVF-ET in the Reproductive Medicine Center of our hospital from January 2015 to October 2018,a total of 1946 treatment cycles.Results:1.Patients with low ovarian response who are <40 years old.According to the ovulation induction program,it was divided into A1 group(COH,n=433),B1 group(minimail stimulation protocol,n=60),and C1 group(natural cycle,n=71).There were no significant differences in BMI,basic endometrium thickness,basal E2 and basal T between groups A1,B1 and C1(P>0.05).The ages(years)of group A1,B1 and C1 were 34.09±3.67,35.36±3.49,34.57±3.52,respectively.The age of group B1 was higher than that of group A1(P<0.05);the basic FSH(m IU/ml)was 12.07±8.03,16.11±8.60,32.22±31.77,respectively(P<0.05);AFC were 6.46±4.28,4.16±3.00,2.62±1.90,respectively(P<0.05);AMH(ng/ml)were 1.72±3.03,0.76±0.73,0.44±0.90,respectively(P<0.05);The number of retrieved oocytes was 5.72±6.05,2.33±1.73,1.38±1.04,respectively(P<0.05);the number of MII oocytes was 5.53±5.85,2.21±1.66,1.23±1.04,respectively(P<0.05);HCG day LH(m IU/ml)were 4.80±15.12,16.49±35.58,33.10±40.64,respectively(P<0.05);the number of embryos obtained was4.99±5.33,1.85±1.50,1.26±1.13,respectively.A1 group was higher than B1 group and C1 group(P<0.05);the number of high quality embryos was 2.49±2.71,1.20±1.23,0.63±0.76,respectively.high quality embryo of group A1.The number was higher than B1 group and C1 group(P<0.05);the number of transplantable embryos was 3.06±2.98,1.41±1.21,0.94±0.98,respectively.The transplantable embryos of group A1 were higher than those of group B1 and C1(P <0.05).HCG day E2 values(pg/ml)was 7871.4 5±9850.19,2546.73±2368.841558,61±1582.94,respectively.the HCG day E2 of group A1 was higher than that of group B1 and C1(P<0.05).the total amount of Gn(IU)of group A1 and group B1 was2271.11±836.15,1516.25±745.93,respectively(P<0.05);Gn days(d)were 10.11±2.68 and 8.86±2.79,respectively(P<0.05).The fertilization rates of A1,B1 and C1 groups were 80.2%,72.1%,81.6%,respectively(P>0.05);the implantation rates were 31.6%,25.0%,9.1%,respectively(P>0.05).the abortion rates were 9.2%,0%,0%respectively(P>0.05);.the clinical pregnancy rate of transplantation was 40.7%,28.6%,12.5%,respectively(P>0.05);the ovulation induction pregnancy rate was20.1%,3.3%,1.4%,respectively(P<0.05);the cycle cancellation rate were 50.6%,88.3%,88.7%,respectively.the cycle cancellation rate in group A1 was lower than that in group B1 and group C1(P<0.05).2.Patients with low ovarian response who are ?40 years old According to the ovulation induction program,it was divided into A2 group(COH n=930),B2 group(minimail stimulation protocol n=160)and C2 group(natural cycle n=292)There were no significant differences in infertility years,BMI,basic E2 and T between the A2,B2 and C2 groups(P>0.05).The ages(years)of the A2,B2 and C2 groups were42.64±1.72,43.01±1.90,44.00±2.46,respectively(P<0.05);AFC were 4.86±2.69,3.76±1.73,2.71±1.59,respectively(P<0.05);AMH(ng/ml)were 1.36±1.33,0.50±0.43,0.45±0.48,respectively(P<0.05);the basic FSH(m IU/ml)were 13.59±5.47,17.68±8.71,33.39±13.02,respectively(P<0.05);the HCG day E2 values(pg/ml)was5718.68±4946.18 and 3029.76±7057.17,1014.75±1215.11,respectively(P<0.05);HCG day LH values(m IU/ml)were 5.56±10.25,12.26±19.84,25.93±26.07,respectively(P<0.05);.HCG day endometrium thickness(mm)was10.24± 3.49,8.09 ± 2.53,9.50 ± 2.48 respectively,(P < 0.05);The number of retrieved oocytes was 4.26±3.63,2.27±1.70,1.77±1.10,respectively.The number of retrieved oocytes in group A2 was higher than that in group B2 and C2(P<0.05),and the number of high-quality embryos was 1.90±2.07.1.00±1.23,0.92±0.92,,respectively.the number of high quality embryos in group A2 was higher than that in group B2 and C2(P<0.05);the cycle cancellation rate was 49.7%,75.0%,84.5%,respectively(P<0.05);The ovulation cycle pregnancy was higher in the A2 group than in the B2 and C2 groups(P<0.05).the clinical pregnancy rate of transplantation were 12.2%,7.3%,and 6.4%,respectively(P>0.05).The abortion rates were 35.08%,100%,100%,respectively.The abortion rate of the A2 group was lower than that of the B2 and C2 groups(P<0.05).3.Ovarian low-response patients using COH were in the A3 group(age <40years old group n=433)and the A4 group(age ?40 years old group n=930).AMH(ng/ml)of A3 and A4 groups were 1.72±3.03,1.36±1.33,respectively(P<0.05);AFC were 6.46±4.28 and 4.86±2.69,respectively(P<0.05);basic FSH(m IU/ml)were12.07±8.03 and 13.59±5.47,respectively(P<0.05);The number of retrieved oocytes was 5.72±6.05 and 4.26±3.63,respectively(P<0.05);the cycle cancellation rate was50.6% and 9.2%,respectively.P>0.05);implantation rate was 31.6%,12.9%(P<0.05);abortion rate was 9.2%,35.08%(P<0.05);ovulation induction pregnancy rate was20.1%,6.1%(P <0.05);The clinical pregnancy rate of transplantation was 40.7% and12.2%,respectively(P<0.05).4.Ovarian low-response patients using minimail stimulation protocol,the B3group(age <40 years old n=60)and the B4 group(age ?40 years old n=160),the B3 and B4 groups had no significant infertility years and basic FSH.(P>0.05);AMH(ng/ml)were 0.76±0.73 and 0.50±0.43,respectively(P<0.05);The number of retrieved oocytes was 2.33±1.73 and 2.33±1.73,respectively(P>0.05).the cycle cancellation rate was 88.3% and 74.4%,respectively(P<0.05);the implantation rate was 25% and 4.5%,respectively(P<0.05);the abortion rate was 0% and 100%,respectively(P>0.05);the ovulation induction pregnancy rate was 3.3%,1.9%,respectively(P>0.05);The clinical pregnancy rate of transplantation was 28.6%,7.3%(P>0.05).5.Ovarian low-response patients using a natural cycle ovulation induction regimen in the C4 group(age <40 years old n=71)and C4 group(age?40 years old n=292).There were no significant differences in infertility years and basic FSH between the C3 and C4 groups(P>0.05).the cycle cancellation rate of C3 and C4 were 88.7% and 83.9%,respectively(P>0.05).The implantation rates were 9.1% and5.4%,respectively(P>0.05).The abortion rates were 0% and 100%,respectively(P>0.05).The ovulation induction pregnancy rate was 1.4%,1.0%(P>0.05);the clinical pregnancy rate of transplantation was 12.5%,6.4%(P>0.05).6.In order to reduce the age difference,patients with low ovarian response were grouped according to age,and group A5(COH): B5(minimail stimulation protocol):C3 group(natural cycle)was paired 1:1:1(age control 2 years old)Within 160 minutes of each migration time according to the serial number.There were no significant differences in age,infertility,BMI,basic LH,E2,and T between the A5,B5,and C5 groups(P>0.05).The AFC in the A5,B5,and C5 groups were 4.56±2.20,3.74±1.71,respectively.2.70±1.58(P < 0.05).The basic FSH(m IU/ml)were13.58±4.76,17.68±8.71,32.08±11.19(P<0.05).AMH(ng/ml)were 1.51±1.69,0.50±0.43,0.38±0.39,respectively(P<0.05).The number of retrieved oocytes was4.36±3.73,2.27±1.70,and 1.66±1.07(P<0.05).The HCG day E2(pg/ml)was5.19±5.08,12.26±19.84,23.48±21.96(P<0.05).The HCG day LH(m IU/ml)was4.36±3.73,2.27±1.70,and 1.66±1.07,respectively(P<0.05).The ovulation induction pregnancy rates were 4.4%,1.9%,and 1.3%,respectively.The ovulation induction pregnancy in the A5 group was higher than that in the B5 and C5 groups(P>0.05).the clinical pregnancy rate of transplantation were 10.3%,7.3%,8.3%,respectively.>0.05);the cycle cancellation rate were 56.0%,75%,85.1%,respectively(P<0.05);the fertilization rates were 79.2%,77.5%,80.1%,respectively(P>0.05);the implantation rates were 9.1%,4.5,respectively.%,8.0%(P>0.05);the abortion rate was 14%,100%,100%,respectively.The abortion rate of A5 group was lower than that of B5 group and C5 group(P<0.05).7.to understand the clinical effect of AMH in patients with POR,COH in the41-42 years old ovarian low response patients.Group A6 according to AMH(AMH < 1.0 ng/ml n=93);Group B6(AMH?1.0 ng/ml n=114).There were no significant differences in age,infertility years,basic E2,LH,T,and basic endometrium thickness between the A6 and B6 groups(P>0.05).The AFC in the A4 and B4 groups were4.23±1.55,5.28±2.90,respectively.(P<0.05);basic FSH(m IU/ml)were 14.61±5.38,11.59±3.19,respectively(P<0.05),The number of retrieved oocytes was 2.82±1.89 and 6.46±4.28,respectively(P<0.05);The number of MII oocytes was 2.73±1.89 and6.08±3.93,respectively(P<0.05);The number of 2PN oocytes were 2.41±1.79 and5.15±3.35,respectively(P<0.05);the number of embryos obtained was 2.58.±1.81,5.56±3.59(P<0.05);the number of high-quality embryos were 1.44±1.41 and3.07±2.71,respectively(P<0.05);the total amount of Gn(IU)was 2728.01±775.47 and 2505.32±848.10,respectively.<0.05);Gn days(d)were 9.65±2.57,10.51±2.61,respectively(P<0.05).The cycle cancellation rates of A6 and B6 groups were 65.6%and 36.0%,respectively(P<0.05);the fertilization rates were 85.4%,79.8%,respectively(P<0.05);the MII oocyte rates were 96.6%,94.2%,respectively(P>0.05).The high-quality embryo rate was 58.8%,59.4%,respectively(P>0.05);the implantation rate was 8.7%,13.3%,respectively(P>0.05);the abortion rate was25%,33.3%,respectively(P>0.05);the clinical pregnancy rate of transplantation was12.5% and 20.5%(P>0.05).The ovulation induction pregnancy rate was 4.3% and13.2%,respectively(P<0.05).conclusion: Patients who are over 43 years old and The number of eggs obtained was less than 4.Although the number of oocytes obtained and the cancellation rate of transplantation cycle in COH regimen were better than that in micro-stimulation regimen,there was no significant difference in the final clinical pregnancy rate.However,the micro-stimulation program can reduce the amount of Gn,significantly reduce the cost,and has certain advantages. |
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