The Efficiency Of Ultra Long Protocol In The Patients Who Underwent IVF/ICSI Failures Using PPOS Protocol

Objective:To analyze the IVF/ICSI outcomes and pregnancy outcomes in the ultra long protocol and PPOS protocol using self-control method.To investigate whether the ultra long protocol can be an alternative treatment for same patients with repeated IVF/ICSI failures.Methods: A retrospective study was conducted on patients who underwent IVF/ICSI failures using PPOS protocol and switched to the ultra long protocol.According to the failure reasons,the patients were divided into three subgroups,subgroup A(once poor oocyte developmental competence,n=88),subgroup B(repeated poor oocyte developmental competence n=115)and subgroup C(repeated implantation failures,n=84).And another control group was set up as PPOS protocol used in the second cycle again.The IVF/ICSI outcomes and pregnancy outcomes were analyzed,at the same time,the endocrine profiles were observed.Results: Compare subgroup A with the control group,PPOS group had higher good-quality embryo rate,but the ultra long group(subgroup A)had more viable embryos,higher utilization rate and lower cancellation rate(18.4% vs.5.7%).The chemical pregnancy rate,clinical pregnancy rate,ongoing pregnancy rate and implantation rate were higher in subgroup A than the control group.We compared the ultra group with their previous group in subgroup A,the ultra long protocol had more retrieved oocyte(9.3±4.8 vs.7.6±4.7),mature oocyte(7.9±4.3 vs.5.9±4.0;),normal fertilized oocyte(6.5±4.1vs.3.7±2.7),good-quality embryo(1(0,3)vs.0(0,1))and viable embryos(3.0±2.2 vs.0.9±0.9)(all P<0.05).And the cancellation rate was lower in the ultra long protocol(5.7% vs.39.8%),all difference reach the significance(P<0.05).The cumulative pregnancy rate was higher in the ultra long group.Both the changed group and unchanged group improved the embryo quality.In subgroup B,the ultra long group had more third day good-quality embryo(0(0,1)vs.0(0,0),P<0.05)and more viable embryos(2(1,2)vs.0(0,1),P<0.05)。There was no significant difference in the oocyte retrieved rate(70.4% vs.67.3%,P>0.05)and normal fertilization rate(73.6% vs.74.9%,P>0.05),the ultra long group had higher mature oocyte rate(83.1% vs.78.2%,P<0.05),good-quality embryo rate(16.7% vs.4.4%,P<0.05)and ultilization rate(21.9% vs.6.8%,P<0.05)than PPOS group.There was a significantly difference in the cancellation rate(13.9% vs.63.5%;P<0.05).The ultra long group had higher cumulative pregnancy rate(37.3% vs.10.3%)and higher predicted cumulative pregnancy rate(36.9% vs.14.3%)than PPOS protocol(P<0.05).Multivariable regression analysis indicated that odds of a clinical pregnancy were significantly increased with mature oocyte number(OR 1.321;P=0.003)and Gn doses per oocyte(OR 1.002;P=0.039)as well as decreasing age(OR 0.889;P=0.044)and infertility duration(OR 0.852;P=0.023).In subgroup C,there were no significance in the retrieved oocytes,normal fertilized oocytes,cleaved embryos,good-quality embryos and viable embryos(P>0.05).However,the ultra long protocol had more mature oocyte rate(87.8% vs.82.7%,P<0.05).The ultra long protocol had significantly higher biochemical pregnancy rate(39.8% vs.0.0%),clinical pregnancy rate(37.5%vs.0.0%),ongoing pregnancy rate(33.0% vs.0.0%)and implantation rate(24.8% vs.0.0%)than PPOS group(P<0.05).Conclusion: For the patients who had low oocyte utilization rate only once,they will get a better result than their first cycle,but the patients who changed to ultra long protocol will perform best.If the patients underwent repeated IVF/ICSI failures and had poor oocyte competence,they will get more good-quality embryo and have more chance of transferring when using the ultra long protocol combined with fresh ET.On the other hand,as far as those RIF patients are concerned,the oocyte and embryo did not change in the ultra long protocol,however,the pregnancy rate increased in both fresh ET and FET group.FET had higher pregnancy rate than ET.Different COH protocol and transfer strategies may have better effect on the previous failure patients.The mechanism is still not very clear and more characteristics should be explored to search the personal COH protocol.