Study On The Influencing Factors Of The Oocyte Retrieval Rate Of The First Follicle In Diminished Ovarian Reserve

Background:In-vitro fertilization embryo transfer(IVF-ET)is an effective treatment for infertility.However,the patients with diminished ovarian reserve(DOR)have fewer follicles with a higher cancellation rate due to retrieval failure.So,the success of IVF in the DOR patients is a great challenge in IVF clinic.For the improvement of IVF outcome in DOR patients,it is necessary to analyze the influencing factors leading to retrieval failure and investigate the possible way to improve treatment.Objective:1.To identify the factors associated with the oocyte retrieval outcome of the first follicle in patients with DOR undergoing IVF treatment;2.To evaluate the judgement power of individual factor for oocyte retrieval outcome in the first follicle;3.To evaluate the effect of different trigger protocols on oocyte retrieval outcomes in DOR population.Methods:A total of 151 DOR patients with the age<38 years,who received IVF-ET treatment at the People's Hospital of Zhejiang Province from July to December 2017,have been recruited into this study.All patients were categorized as successful retrieval group(success group)or non-retrieval one(failure group)if the oocyte be retrieved from the first follicle punctured successfully or not.There were 73 cases taking hCG for triggering oocyte maturation,of which 39 cases had successful oocyte retrieval in the first follicle,and 78 cases taking GnRH-a with 53 success for the first follicle.Clinical data were collected and HA,E2,and P levels in the follicular fluid of the first dominant follicle measured.Results:1.The serum level of anti-Mullerian hormone(AMH)in success group was significantly higher than that in the failure one,and this difference independent of the trigger protocol(hCG group:0.75±0.42 ng/ml vs 0.55±0.37 ng/ml,P<0.05;GnRH-a group 0.70±0.52 ng/ml vs 0.44± 0.27 ng/ml,P<0.05).2.Serum AMH(OR:8.503,95%CI:2.160?33.484,P<0.01)and HA levels in follicular fluid(OR:1.012,95%CI:1.005?1.018,P<0.001)were positively related to oocyte retrieval in the first follicle as evaluated by multivariate logistic regression model,and the follicular fluid E2 level negatively correlated(OR:0.889,95%CI:0.816?0.969,P<0.01).GnRH-a trigger yielded a significantly higher retrieval rate than hCG(OR:3.314,95%CI:1.444?7.607,P<0.01).The area under the sensitivity curve(AUC)of the follicular fluid HA,serum AMH,trigger and follicular fluid E2 were 0.685,0.663,0.576,and 0.370,respectively.3.There was a significant difference in oocyte retrieval rate(62.9%vs 70.3%,P<0.001)in overall follicles punctured between the hCG and GnRH-a groups,but none difference in the maturity of the cumulus-oocyte complexes obtained.For successful cases,HA concentration in follicular fluid was different between two trigger protocols(347±86 ng/ml vs 296±71 ng/ml,P<0.01).Conclusion:In DOR population,serum AMH concentration,follicular fluid HA concentration,trigger protocols and follicular fluid E2 concentration are associated with the oocyte retrieval.HA in FF has been identified as the best marker to analyze the reason of oocyte retrieval failure.GnRH-a may have an evident superiority over hCG in promoting oocyte retrieval rate in DOR.