The Clinical Application Of Pituitary Down-regulation And Estrogen-progesterone Program In Frozen-thawed Embryo Transfer

BackgroundFrozen-thawed embryo transfer(FET) as in vitro fertilization-embryo transfer (IVF-ET) supplement,patient’s remaining good quality embryos can be cryopreserved,which is transplanted at a later appropriate time greatly improved once COH cumulative pregnancy rate,which reduce the number of ovulation induction-IVF cycle,and which can reduce the incidence of ovarian hyperstimulation syndrome (OHSS) or reduce its severity,but also make greatly reduce the risk of multiple pregnancy (especially high sequence multiple pregnancy),and can reduce the economic burden of the patients.In addition, some special cases,such as patients who is OHSS,after ovarian surgery or cancer not suitable for embryo transplant,which can save embryos to be transplanted in a optional opportunity. in order to preserve the fertility of the patient.Therefore, how to improve embryo implantation rate and pregnancy rate of frozen embryo transfer has become a research focus in the current field of assisted reproduction. One of the keys of frozen embryo transfer to successful pregnancy is the synchronization of endometrial and embryonic development,whether the endometrium is too thick or too thin can affect embryo implantation.How to prepare the endometrial of frozen embryo transfer is one of the important issues in current research. ObjectiveThe role of the down-regulation of gonadotropin-releasing hormone analogues (GnRH-a) not only can make follicular development synchronize,but also can improve endometrial receptivity. Patients with specific conditions,in the Frozen-thawed Embryo Transfer(FET),using the down-regulation and estrogen-progesterone program (down-regulation+E-P program) as a method of endometrial preparation, comparing with the natural cycle programs and the Oral Contraceptive Pill(OC) and estrogen-progesterone program (OC+E-P program), explore the clinical value of the down-regulation+E-P program as a endometrial preparation method in Frozen-thawed Embryo Transfer(FET)MethodsInformation collected in Reproductive Center of the First Affiliated Hospital of Zhengzhou University, from March2011to December2012,639frozen-thawed embryo transfer cycles,retrospective analysis of the down-regulation and E-P program with the natural cycle program and OC+E-P program patient’s age,body mass index, duration of infertility,foundational endocrine (FSH,LH,E2) level, endometrial thickness and morphology of the determination day of transplantation,the average number of embryos transferred, the number of high quality embryo transplantation,biochemical pregnancy rate,clinical pregnancy rate and ectopic pregnancy rate,in order to find whether there are differences.Results1. Three kinds of endometrial preparation program in age, body mass index, duration of infertility,foundational endocrine level,the number of embryos transferred, the number of high quality embryo transplantation, the high-quality embryo rate and the endometrial thickness on the determination day of transplantation was not statistically significant (P＞0.05).2. The biochemical pregnancy and clinical pregnancy rate of down-regulation+E-P group patients is higher than natural cycle group and OC+E-P group, three groups in biochemical pregnancy, clinical pregnancy rate is statistically significant (P＜0.05), while three kinds of preparedness programs in ectopic pregnancy rate is no statistical significance (P>0.05).3. In639FET cycles,258cases of clinical pregnancy,381cases of non-clinical pregnancy, the endometrial thickness and morphology between the two groups is not statistically significant.Conclusions1. For patients who repeatedly failed in frozen-thawed embryo transfer, Down regulation and estrogen-progesterone program, comparing with the natural cycle program and OC+E-P program, can obtain better clinical pregnancy rate, Down-regulation and estrogen-progesterone program is possible as a assisted reproductive method of patients who repeatedly failed in frozen-thawed embryo transfer.2. Endometrial thickness and morphology affect the clinical pregnancy rate of frozen-thawed embryo transfer,but not is the single factor affecting the the endometrial receptivity. If endometrial thickness reached the minimum endometrial thickness of pregnancy required, the frozen-thawed embryo can be transplanted.3. The choice of different patient’s endometrial preparation methods in the frozen-thawed embryo transfer cycles,using different programs to treat individualizely.