Analysis of clinical pregnancy outcome of progesterone elevation with two kinds of down-regulation methods using gonadotropin-releasing hormone agonist
10.3760/cma.j.cn101441-20201019-00569
- VernacularTitle:两种促性腺激素释放激素激动剂降调节方案晚卵泡期孕酮升高的临床结局分析
- Author:
Yi ZENG
1
;
Wei DAI
1
;
Yile ZHANG
1
;
Hao SHI
1
;
Yingpu SUN
1
Author Information
1. 郑州大学第一附属医院生殖医学中心 450052
- Publication Type:Journal Article
- Keywords:
Pituitary down-regulation;
Progesterone elevation;
Clinical pregnancy outcome
- From:
Chinese Journal of Reproduction and Contraception
2021;41(4):320-326
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the clinical pregnancy outcomes of progesterone elevation cycles with follicular phase gonadotropin-releasing hormone agonist (GnRH-a) long-acting protocol and luteal phase GnRH-a short-acting protocol.Methods:In this retrospective cohort study, data of patients who received in vitro fertilization/intracytoplasmic sperm injecion (IVF/ICSI) treatment with fresh cleavage phase embryo transferred and follicular phase GnRH-a long-acting protocol or luteal phase GnRH-a short-acting protocol at the Reproductive Medical Center of the First Affiliated Hospital of Zhengzhou University between January 2015 and December 2018 were analyzed. We matched the above patient cycles with age, basal follicle-stimulating hormone (FSH) and number of transplanted embryos using propensity score matching (PSM). There were 1748 cases received long-acting protocol (group A) and 1751 cases received short-acting protocol (group B). According to the different concentrations of progesterone on human chorionic gonadotropin (hCG) injection day, patients were divided into four subgroups: <1.00 μg/L (group 1), 1.00-1.25 μg/L (group 2), 1.25-1.75 μg/L (group 3) and 1.75-3.00 μg/L (group 4). We compared the different items among subgroups in group A and group B including clinical pregnancy, miscarriage rate, and so on. Results:The clinical pregnancy rate of group A was higher than that of group B [65.5% (1145/1748) vs. 53.6% (938/1751), P<0.001], and the live birth rate of group A was higher than that of group B [55.7% (973/1748) vs. 44.0% (770/1751), P<0.001], both of the differences were statistically significant. The clinical pregnancy rate of subgroup A4 [56.6% (82/145)] was significantly lower than that of subgroup A1 [66.8% (725/1086), P=0.010] and subgroup A2 [69.3% (167/241), P=0.008]. In group B, the clinical pregnancy rate of subgroup B3 and subgroup B4 [43.6% (68/156), 30.8% (12/39)] was significantly lower than that of subgroup B1 [55.4% (728/1315)] and subgroup B2 [55.2% (127/230)], the differences were statistically significant (subgroup B3 vs. subgroup B1, P=0.003; subgroup B4 vs. subgroup B1, P=0.002; subgroup B3 vs. subgroup B2, P=0.016; subgroup B4 vs. subgroup B2, P=0.004). Adjusted for confounding factors, the results of multi-factor logistics analysis showed that: compared with subgroup A1, other subgroups (subgroup A2: OR=1.090, 95% CI=0.787-1.509, P=0.606; subgroup A3: OR=0.809, 95% CI=0.588-1.114, P=0.194; subgroup A4: OR=0.675, 95% CI=0.456-1.000, P=0.050) in group A had no statistically significant difference in clinical pregnancy rate. Compared with subgroup B1, the clinical pregnancy rate of subgroup B4 was significantly lower in group B ( OR=0.410, 95% CI=0.199-0.843, P=0.015). Conclusion:After PSM matching, the clinical pregnancy rate and the live birth rate of follicular phase GnRH-a long-acting protocol were better than those of luteal phase GnRH-a short-acting protocol. The follicular phase GnRH-a long-acting protocol had better tolerance to the negative effects of high progesterone than that of luteal phase GnRH-a short-acting protocol.
