波塞冬1组患者重复周期应用早卵泡期长效长方案和拮抗剂方案的疗效比较及自身对照研究OACSTPCD

Objective:To investigate the application efficacy and optimization strategy of early follicular phase long-acting long protocol and antagonist protocol in repeated cycles of the patients in Poseidon group 1. Methods:A total of 286 patients in Poseidon 1 group who underwent IVF/ICSI and experienced unexpected poor ovarian response(uPOR)after using conventional controlled ovarian hyper-stimulation(COH)protocol and accepted assistant pregnancy again after failed to conceive at the reproductive center of Anhui Maternal &Child Health Hospital from June 2018 to June 2022 were selected.According to the different COH protocols in repeated cycles,the patients were divided into two groups:the early follicular phase long-acting long protocol group(long-acting long protocol group,n=119)and antagonist protocol group(n=167).The laboratory data and clinical outcomes of the two groups were compared.Meanwhile,124 patients who used the same COH protocol in both cycles were divided into two groups:double long-acting long protocol group(n=70)and double antagonist protocol group(n=54).The clinical data of the two groups were analyzed by self-control study. Results:(1)There was no significant difference in basic data between patients in the long-acting long protocol and the antagonist protocol group(P＞0.05).Total dosage of gondotropin(Gn)used,duration of Gn used,E2 level on HCG day,number of oocytes retrieved,number of available embryos in the long-acting long protocol group were significantly higher than those in the antagonist protocol group(P＜0.05).while the LH level on HCG day was significantly lower than that of the antagonist group(P＜0.05).The fresh cycle embryo implantation rate and clinical pregnancy rate,cumulative pregnancy rate in the long-acting long protocol group were slightly higher than those in the antagonist protocol group,but there was no significant difference(P＞0.05).There were no significant differences in the cycle cancellation rate,incidence of moderate and severe OHSS,progesterone level and endometrial thickness on HCG day,incidence of recurrent uPOR and early abortion rate between the two groups(P＞0.05).(2)The self-control comparison of double the long-term protocol group showed that the initial dose of Gn,the amount of LH addition,E2 level on HCG day,number of oocytes retrieved,number of available embryos,number of good-quality embryos,normal fertilization rate,high-quality embryo rate,fresh embryo implantation rate and clinical pregnancy rate in the second cycle were significantly higher than those in the first cycle(P＜0.05).(3)The self-control comparison of the double antagonist protocol group showed that the initial dose of Gn,the amount of LH addition,number of oocytes retrieved,number of high-quality embryos,the fresh cycle embryo implantation rate and clinical pregnancy rate in the second cycle were significantly higher than those in the first cycle(P＜0.05). Conclusions:For the patients in Poseidon group 1,both the early follicular phase long-acting long protocol and antagonist protocol can be used as COH protocols in repeated cycles.In terms of number of oocytes retrieved and the clinical pregnancy outcome of fresh cycle,the early follicular phase long-acting long protocol is superior to the antagonist protocol.In terms of economic cost,the antagonist protocol is better than the early follicular phase long-acting long protocol.According to the disadvantages of the two protocols,optimization strategies can be taken to improve the patient's responsiveness of COH and the quality and quantity of oocytes,so as to improve the prognosis of IVF/ICSI.