Application of estrogen pretreatment in different ovarian responsers with the gonadotrophin-releasing hormone antagonist protocol
10.3760/cma.j.cn101441-20190816-00360
- VernacularTitle:雌激素预处理在不同卵巢反应人群使用拮抗剂方案中的应用研究
- Author:
Caixia WANG
1
;
Yun LIU
1
;
Wujian HUANG
1
;
Lingyun HE
1
;
Hongmei XU
1
;
Lihua MAO
1
;
Jinhua WANG
1
Author Information
1. 福建医科大学福总临床医学院（第九〇〇医院）/厦门大学附属东方医院（第九〇〇医院）妇产科/福建中医药大学福总教学医院（第九〇〇医院）生殖医学中心，福州 350025
- Publication Type:Journal Article
- Keywords:
Gonadotrophin-releasing hormone antagonist protocol;
Estrogen pretreatment;
Homogeneity of follicular development
- From:
Chinese Journal of Reproduction and Contraception
2020;40(9):708-715
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the effects of estrogen pretreatment on the outcomes of in vitrofertilization and embryo transfer (IVF-ET) treatment of gonadotrophin-releasing hormone antagonist (GnRH-A) protocol with controlled ovarian hyperstimulation. Methods:Retrospective analysis was performed on the clinical data of 1042 patients who have underwent IVF-ET treatment of GnRH-A protocol in the Center of Reproductive Medicine Teaching Hospital of Fujian University of Traditional Chinese Medicine from January 2015 to December 2016. According to whether the estrogen pretreatment were conducted, patients were divided into pretreatment group and non-pretreatment group. Clinical data and treatment outcomes of IVF-ET between two groups were compared according to different ovarian reactions (high response, normal response, and low response).Results:Compared with non-pretreatment group, the level of serum follicle stimulation hormone (FSH) and luteinizing hormone (LH), antral follicle diameter and coefficent of varience (CV) significantly decreased in pretreatment group (all P<0.001). Total dosage and duration of gonadotropin (Gn) used [(1 693.4±569.8) IU， (2 242.5±635.8) IU， (2 686.4±833.8) IU； (9.7±1.1) d， (9.6±1.1) d， (9.5±1.6) d] in non-pretreatment group were less than those in pretreatment group [(1 897.9±508.0) IU， (2 458.9±759.1) IU， (2 942.1±756.0) IU； (10.8±1.1) d， (10.5±1.4) d， (10.5±1.6) d] ( P<0.001， P=0.019， P=0.029； P<0.001， P<0.001， P<0.001). In patients with normal ovarian response and poor ovarian response, the follicular unsynchronization rate in Gn used day 5/6, day 7/8 and the day of human chorionic gonadotropin (hCG) injection significantly reduced with estrogen pretreatment (all P<0.05), and the number of follicles with a diameter≥14 mm on the day of hCG injection, the number of oocytes retrieved and mature oocytes, two pronuclear fertilization rate and the number of high-quality embryos of pretreatment group were larger than those of non-pretreatment group (all P<0.05). In patients with high ovarian response, the follicular unsynchronization rate (17.7%) in Gn used day 5/6 of pretreatment group was lower than that of non-pretreatment group (26.7%, P=0.012), while other clinical outcomes and indexes relevant to the laboratory of two groups were not statistically significant (all P>0.05). In patients with normal and poor ovarian response, the differences in the number of oocytes retrieved, mature oocytes, and high-quality embryos between pretreatment group and non-pretreatment group were statistically significant ( P<0.001, P<0.001; P<0.001, P<0.001; P<0.001, P=0.018).In patients with normal ovarian response, the cumulative clinical pregnancy rate (81.3%) of pretreatment group was higher than that of non-pretreatment group (70.5%， P=0.044). In people with different ovarian responses, the clinical pregnancy rate, the miscarriage rate in fresh cycle and the clinical pregnancy rate in the first thaw cycle after freeze-all were not statistically significant between the two groups (all P>0.05). Conclusion:In patients with normal and poor ovarian response, estrogen pretreatment before GnRH-A protocol can improve the homogeneity of follicular development, increase the number of mature oocytes and high-quality embryos, and thus improve clinical pregnancy outcomes. While in patients with high ovarian response, estrogen pretreatment show no superiority and clinical application value for its larger total Gn dosage and stimulation duration.
