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@#【Objective】To investigate the effect of adding different preparations containing luteinizing hormone activity in patients with normal ovarian reserve but suboptimal response during GnRH agonist protocol when undergoing IVF/ICSI- ET.【Methods】872 infertile patients with normal ovarian reserve but suboptimal response to FSH during GnRH agonist protocol were enrolled. According to the supplementation of different preparations containing LH activity ，patients were divided into three groups，including low- dose hCG group（n=28），rLH group（n=319）and HMG group（n=525）. The clinical parameters and pregnancy outcomes were retrospectively compared among three groups.【Results】The proportion of ultra-long GnRH-a protocol in hCG group was higher than that in HMG group（14.3% vs. 1.1%，P＜0.001）. The total duration and dosage gonadotrophin in hCG group were more than that in HMG group ［15.0（13.0~16.8）vs. 13.0（12.0~15.0）days ，P = 0.027 ；2 925（2 531~3 900）vs. 2 550（2 100~3 225）U ，P = 0.046］. The total duration and dosage gonadotrophin in rLH group were less than that in HMG group［13.0（12.0~14.0）vs. 13.0（12.0~15.0）days，P = 0.009；2 400（1 950~3 075）vs. 2 550（2 100~3 225）U ，P = 0.009］. There were 53.6%（15/28）patients who still showed suboptimal response after the administration of HMG or rLH in hCG group. The clinical pregnancy rate（69.2%，58.6% vs.63.8%；P＞0.05）and live birth rate（65.4%，49.6% vs. 53.1%；P＞0.05）were similar among these groups.【Conclusions】 For patients with normal ovarian reserve but suboptimal response during GnRH agonist protocol ，the supplementation of different preparations containing LH activity showed comparable effect on pregnancy outcomes. The addition of low- dose hCG was effective even when patients still showed suboptimal response after the administration of HMG or rLH.
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[Objective] To investigate the effects of different doses of gonadotropin releasing hormone agonist (GnRH-α) on the down-regulation of normal ovarian reserve,and compared the down-regulation level as well as the clinical outcome of in vitro fertilization and embryo transfer (IVF-ET) cycles.[Methods] This RCT study included 63 infertility couples of age＜35 yrs.women with normal ovarian reserve function who were intended to received GnRH-α long protocol treatment.Of the 63 women were randomly divided into three groups according to the dose of triptorelin,21 received daily 0.05 mg short-acting GnRH-α,21 received daily 0.1 mg short-acting GnRH-α,while 21 received reduced-dose depot of 1.25 mg GnRH-αt.[Results] In the three groups,the average duration of down-regulation reached after injection of GnRH-α,the level of LH and E2,the total number of antral follicles,the number of antral follicles of ＜4 mm and 8～9 mm were similar.The serum follicle-stimulating hormone level on the day of gonadotropin initiation were significantly higher in the two short-acting groups compared with the long-acting group [(3.92 ± 1.12) U vs.(3.03 ± 1.14) U vs.(2.05 ± 1.12) U,P＜ 0.001].Four hours after the GnRHa injection,the serum FSH,LH levels were higher in short-acting 0.05 mg group than the short-acting short-acting 0.1 mg group.Both number of days of gonadotropin stimulation and gonadotropin doses were similar in three groups.On the day of hCG administration,the numbers of 14-18mm diameter follicles [(3.91 ±2.12) vs.(5.81 ±3.55) vs.(6.43±3.39),P＜0.001] as well as the proportion of follicles with diameter ≥18 mm/≥10 mm [(33.1％± 13.2％) vs.(24.0％±12.4％) vs.(30.1％±12.2％),P＜0.05],were both statistically significant different in three groups.Although serum LH level on hCG day was significantly increased in 0.05 mg group [(2.47±1.33) U vs.(1.80±0.69) U vs.(1.43±0.53) U,P＜0.05].No premature LH surge and premature ovulation was observed.The number of retrieved oocyteswas significant different [(10.14±4.80) vs.(11.51±2.42) vs.(12.79±2.73),P＜0.05].However,no significant differences was found regard to the number of MII oocytes,and the serum estrogen level per egg was significant higher in 0.05 mg group [(282.33±42.13) U vs.(221.62±32.02) U vs.(200.03±37.89) U,P＜0.001].The live birth rate (LBR) of these three groups in fresh cycles were 61.9％,55.0％,and 50.0％,respectively.The cumulative LBR were 85.7％,76.2％,and 75.0％,respectively.A increased trend was observed in the clinical pregnancy rate,cumulative clinical pregnancy rate and cumulative LBR in 0.05 mg group than the other two groups.[Conclusion] For women with normal ovarian reserve,as the GnRH-α dosage decreased,the down-regulation of pituitary reduced,while serum LH levels on the day of hCG trigger increased.The number of oocytes retrieved was decreased,the proportion of cycles which retrieved ＞ 15 oocytes was also lower.However,the average estrogen level per egg was significant increased,and a better clinical outcome of IVF-ET was received.
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Objective Clinical efficacy was compared among single injections of different doses of long acting gonadotropin releasing hormone agonist (GnRH-a),and daily injections of short-acting GnRH-a in order to evaluate different methods of ovarian stimulation for in vitro fertilization (IVF) cycles.Methods A retrospective study of 214 patients who underwent IVF assisted fertility treatments was conducted.Patients were allocated into four study groups:the short protocol (group A),in which daily injections of 0.1 mg GnRH-a was administered in the mid-luteal phase until the day of human chorionic gonadotropin (hCG) administration (see below);or the long protocol (group B,C & D),in which single injections of 3.75mg,2.0mg,or 0.9mg of long-acting GnRH-a was given in the mid-luteal phase,respectively.Stimulation with gonadotropins (Gn) started when pituitary down-regulation was established.When vaginal ultrasonographic scans showed that at least two follicles had reached 16-20mm in diameter,Gn stimulation was withdrawn,and serum estradiol (E2),progesterone (P),and luteinizing hormone (LH) were determined.Additionally,human chorionic gonadotropin (hCG) was administered that evening.Egg collection was performed 38 hours after hCG injection and the standard IVF procedure was performed.Results There were no statistically significant differences amongst the four groups when measuring serum LH levels,number of oocytes,number of fertilized eggs,number of good quality embryos,and clinical pregnancy rate.The total amount of Gn administered was almost identical when comparing group A and group D,as well as when comparing group B and group C.However,Group A and D required less Gn stimulation to exhibit follicles of 16-20mm in diameter,compared to group B and C (P ＜0.005).Moreover,there was a significant difference in the time required for ovulation induction between group A and group C,where group A had a shorter time to ovulation.The fertilization rate was statistically different between group B and other groups (P ＜ 0.005).Conclusion Through our data analysis,we conclude based on outcome,cost,side-effects,and simplification of treatments,that the 0.9mg long-acting GnRH-a treatment is eminent for ovarian stimulation for IVF.
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Objective To explore the efficacy of long- and short-acting triptorelin on pituitary down-regulation in long protocol and the pregnancy outcome in vitro fertilization and embryo transfer (IVF-ET) . Methods Three hundred and seventeen patients for IVF-ET were enrolled as study and randomized them into two groups. In group A (n=145), patients received single dose subcutaneous injection of 1.25 mg long-acting diphereline in mid-luteal phase. In group B (n=172), patients received 0.1 mg/d subcutaneous injection of short-acting diphereline in mid-luteal phase for 14-18 days until pituitary suppression were got,and then reduced to 0.05 mg/d until the injection of HCG. Results The dose and the days of gonadotropin administration in group A were bigger and longer than those in group B ( 0.05) . But clinical pregnancy rate of group B had increasing trend. Conclusion Administration of short-acting diphereline has the similar effect with that of long-acting diphereline on pituitary down-regulation in long protocol. Short-acting diphereline requires lower amount of gonadotropin and is more flexible,so it should be recommended.