Comparison Study Of The Outcome For Antagonist Protocol And Long-term Long-protocol In IVF-ET Of Patients With PCOS

BackgroundPolycystic ovary syndrome（PCOS）is the most common endocrine system disorder in women of childbearing age,and it is one of the major diseases leading to female infertility.In vitro fertilization-embryo transfer（IVF-ET）is an effective treatment method,and controlled ovarian hyperstimulation（COH）is a key link in IVF-ET.There are various COH schemes,and different COH schemes have their own advantages and disadvantages,how to find a fertility program which has short COH time,less gonadotropin（Gn）dosage,low risk of ovarian hyperstimulation syndrome（OHSS）,high clinical pregnancy rate,low abortion rate and treatment cost according to the characteristics of PCOS patients is a very necessary and urgent problem to be solved.ObjectiveComparative analysis the outcome of gonadotropin-releasing hormone（GnRH）antagonist protocol and long-term gonadotropin-releasing hormone agonist（GnRH-a）long-protocol in IVF-ET of patients with PCOS,and the endometrial development at intramuscular injection of chorionic gonadotropin（HCG）day,uterine artery blood flow and microenvironment related indicators in follicles of the 2 different COH protocol were compared,so as to provide a basis for the treatment of PCOS patients who need assisted reproductive technology for pregnancy.MethodsThe clinical data of 520 patients with PCOS who underwent IVF-ET in reproductive center of Chinese people’s liberation army joint logistics support unit 988 hospital from June 2014 to December 2018 were retrospective analysis,they were divided into antagonist groups（n=242,GnRH antagonist protocol）and long-protocol group（n=278,long-term GnRH-a long-protocol）according to the different COH protocol.The Gn days,the total dose of Gn,the trigger time,the levels of sex hormone at HCG day,the endometrial condition and uterine artery blood flow parameters at HCG day,the levels of microenvironment related index in the follicle,the COH effect,the pregnancy outcome and the incidence rate of OHSS were compared.Results（1）Compared with the antagonist group,the Gn days and the trigger time prolonged significantly in the long-protocol group,and the total dose of Gn increased significantly（P<0.01）.（2）Compared with the antagonist group,the serum level of estradiol（E₂）at HCG day increased significantly in the long-protocol group（P<0.05）,and the serum levels of luteinizing hormone（LH）and rogesterone（P）decreased significantly（P<0.01）.（3）There was no significant difference in the endometrial thickness and the proportion of endometrial morphology of A,B and C at HCG day in the 2 groups（P>0.05）.（4）Compared with the antagonist group,the end-diastolic velocity（EDV）,peak systolic blood flow velocity（PSV）at HCG day increased significantly in the long-protocol group,the pulsation index（PI）,resistance index（RI）and peak systolic blood flow velocity/end-diastolic velocity（S/D）decreased significantly（P<0.05 or P<0.01）.（5）The level of bone morphogenetic protein 15（BMP15）in the follicular fluid of patients in the long-protocol group was significantly higher than that of the antagonist group（P<0.01）,but there was no significant difference in the level of growth differentiation factor 9（GDF9）in the follicular fluid between the 2 groups（P>0.05）.（6）There was no significant difference in the cycle cancellation rate,number of eggs obtained,fertilization rate,cleavage rate and high quality embryo rate between the 2groups（P>0.05）,but the frozen embryos rate in the long-protocol group was significantly lower than the antagonist group（P<0.01）.（7）There were no significant differences in the clinical pregnancy rates of fresh embryos and frozen embryos,biochemical pregnancy rate,early abortion rate,multiple birth rate,ectopic pregnancy rate and live birth rate between the 2 groups（P>0.05）.（8）The incidence of moderate to severe OHSS in the long-protocol group was significantly higher than the antagonist group（P<0.05）.Conclusion（1）The GnRH antagonist protocol is superior to the long-term GnRH-a long-protocol in reducing the Gn days,reducing the total amount of Gn and shortening the trigger time.（2）The quality of embryos formed by in vitro fertilization in PCOS patients had no significant effect of the 2 protocols,and there was no significant effect on clinical pregnancy rates after embryo transfer.（3）GnRH antagonist protocol can significantly reduce the risk of OHSS.（4）Compared with the GnRH antagonist protocol,the long-term GnRH-a long-protocol has a relatively small effect on endometrial receptivity.（5）The long-term GnRH-a long-protocol effectively improved the microenvironment in the follicles of patients with PCOS requiring IVF-ET,which improved the quality of the obtained eggs to some extent,however,whether it will affect the fertility rate and clinical pregnancy rate still needs to be studied in larger samples to confirm.