Clinical application of Gonadotropin-release hormone agonist (GnRH-a) down-regulation in early follicle phase combined with ovarian stimulation by human menopausal gonadotropin (HMG) protocol for patients who have decreased ovarian reserve

Abstract

Abstract: AIM: To investigate the effect of the GnRH-a down-regulation in early follicle phase combined with ovarian stimulation by HMG protocol for patients who have decreased ovarian reserve. METHODS: Clinical retrospective analysis was performed on 109 cycles in total 109 patients received IVF or ICSI treatment between May 2010 and March 2011. The 109 cycles were divided into three groups by stimulation protocol. Group A consisted of cycles with GnRH-a down-regulation protocol. Group B consisted of cycles with mild stimulation protocol. Group C consisted of cycles with GnRH-a flare-up protocol. The clinical and laboratory outcome of three groups were compared. RESULTS: The gonadotropin used in Group B was significantly less than that of Group A and C(P<0.01). The serum level of LH in Group A was significantly lower than that of Group B and C(P<0.01). Group C showed a significant higher level of E₂ compared with Group A and B (P<0.01). No significant difference was observed in the number of oocytes retrieved and the rate of maturation and fertilization(P>0.05). There was no significant difference in the clinical pregnancy rate per transfer in three groups(33.33% vs 32.35% vs 36.00%, P>0.05). The cancel rate was significantly higher in Group B (34.62%) when compared with Group A (11.11%)(P=0.02), but the difference was not significant when it was compared with Group C (16.67%)(P＝0.05).The first-trimester abortion rate of Group C (33.33%)was significantly higher than that of Group A (12.50%, P＝0.028) and Group B (18.18%,P＝0.03). CONCLUSION: GnRH-a down-regulation in early follicle phase combined with HMG protocol could reach a comparable pregnancy rate as mild stimulation protocol and GnRH-a flare-up protocol for patient with decreased ovarian reserve. Furthermore, the cancel rate and the first-trimester abortion rate could be decreased.

Key words: Gonadotropin-releasing hormone agonist, Human menopausal gonadotrophin, Ovarian reserve

CLC Number:

YU Rong, ZHAO Jun-zhao, XIAO Shi-quan, WANG Pei-yu, LIN Jia, YANG Hai-yan. Clinical application of Gonadotropin-release hormone agonist (GnRH-a) down-regulation in early follicle phase combined with ovarian stimulation by human menopausal gonadotropin (HMG) protocol for patients who have decreased ovarian reserve[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2011, 16(9): 1033-1038.

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