Objective:To explore the clinical outcomes of GnRH antagonist protocol in diminished ovarian reserve(DOR)patients who failed to get pregnancy in their first cycle of IVF/ICSI-ET with GnRH agonist(GnRH-a)protocols.Methods:The clinical data of 69 DOR patients who failed to get pregnancy with GnRH-a protocols(including luteal-phase and follicular-phase GnRH-a protocols)at the first cycle,and then used GnRH antagonist protocol in the second cycle in the Reproductive Medical Center of Renmin Hospital of Wuhan University from January 2019 to June 2023 were analyzed retrospectively.The self-controlled analysis was used to compare the clinical outcomes of the two cycles.Results:There were no significant differences in the duration of gonadotropin(Gn)use,total Gn,estradiol(E2)and progesterone(P)levels on trigger day,endometrial thickness on trigger day,and the number of follicles with diameter ≥14 mm on trigger day between the two cycles(P＞0.05).The LH level on trigger day of the second cycle was significantly higher than that of the first cycle[(2.42±1.83)vs.(1.77±1.40)U/L,P＜0.05].The number of oocytes obtained[(6.80±3.56)vs.(5.45±3.83)],MⅡ oocytes[(5.59±3.15)vs.(3.91±3.48)],the fertilization rate(76.03％vs.61.87％),2PN rate(67.97％vs.53.07％),D3 high-quality embryos[(2.61±2.40)vs.(1.25±1.57)],and blastocyst formation rate(44.44％vs.33.56％)in the second cycle were significantly higher than those in the first cycle(P＜0.05).There were no significant differences in 2PN cleavage rate and high-quality blastocyst formation rate between the two cycles(P＞0.05).There were no significant differences in the cancellation rate and ectopic pregnancy rate of fresh embryo transfer between the two cycles(P＞0.05).The HCG positive rate(45.65％vs.18.18％)and clinical pregnancy rate(36.96％vs.12.73％)of fresh embryo transfer in the second cycle were significantly higher than those in the first cycle(P＜0.05),and the abortion rate was significantly lower than that in the first cycle(11.76％vs.85.71％,P＜0.05).Conclusions:For DOR patients who failed to use the GnRH-a regimen for ovulation induction in the first cycle,using the antagonist regimen for ovulation induction in the second cycle can increase the number of retrieved oocytes and high-quality embryos,which is beneficial to improving the clinical outcomes.
关键词
卵巢储备功能减退/体外受精-胚胎移植/激动剂方案/拮抗剂方案/自身对照
Key words
Diminished ovarian reserve/IVF-ET/GnRH agonist protocol/GnRH antagonist protocol/Self-controlled study
维普
万方数据