Changes Of Serum INHB In GnRH Antagonist Protocol And Its Correlation With COH Outcome

Objectives:Through the study on the detection of serum inhibin B（INHB）at various detection times in the GnRH antagonist protocol,the characteristics of the change of serum INHB in the GnRH antagonist protocol and its correlation with the outcome index of controlled hyperstimulation（COH）were discussed.Methods:30 patients treated with in vitro fertilization/intracytoplasmic sperm injection-embryo transfer（IVF/ICSI-ET）assisted technology for the first time were selected in the reproductive center of our hospital from August 2018 to November2019 due to fallopian tube factors and/or male factors.30 cases were prospectively controlled before and after themselves.All patients were treated with a flexible GnRH antagonist protocol.Collect their estradiol（E₂）,follicle stimulating hormone（FSH）,luteinizing hormone（LH）,progesterone（P）,calculate the mean diameter of follicles and count the number of retrieved oocytes,the number of MetaphaseⅡoocytes,the number of 2PN fertilization,the number of cleavage and the number of high-quality embryos on the 3^rdday during COH.All these data above were collected for detecting for six times,including the 2^ndday of natural menstruation（A）,the 2^ndday of menstruation after pretreatment with estradiol（B）,the 5^thor 6^thdays of gonadotropin（Gn）stimulation（C）,the day of the antagonist addition or the day before（D）,the 1^stor 2^ndday after antagonist addition（E）and the trigger day（F）.（1）Analyzed the characteristics of serum INHB at different stages in the GnRH antagonist protocol.（2）The average diameter of the follicular coefficient of variation（CV）was used to evaluate the synchronization of follicular development and the correlation between serum INHB and follicular CV at different detection times was analyzed.（3）Analysis of serum INHB levels includes different detection times,the difference in serum INHB after pretreatment with estradiol（Δ1）and the percentage of decrease in serum INHB after pretreatment with estradiol（Δ2）and COH outcome indicators(the number of retrieved oocytes,the number of MetaphaseⅡoocytes,the number of 2PN fertilization,the number of cleavage and the number of high-quality embryos on the 3^rdday)correlation.（4）According toΔ2,the study subjects were divided into 2groups（group 1:Δ2≥50%;group 2:Δ2<50%）,and the analysis of the two groups of patients was different check whether there is any difference in the follicular synchronization and COH outcomes.Results:（1）Compared with the level before estradiol pretreatment（point A）,the serum INHB level（point B）after pretreatment decreased statistically（P<0.05）.After the initiation of Gn,the serum INHB level increased significantly,and maintained an upward trend until the day when the GnRH antagonist was added or1 day before（point D）,and showed a slight decrease in the the 1^stor 2^ndday after GnRH antagonist addition（E）and continued until the trigger day（point F）.Compared with the level before GnRH antagonist（point D）,the serum INHB level（point E）showed a downward trend after addition,but the difference was not statistically significant（P>0.05）.The serum INHB and FSH levels were significantly positively correlated during COH（R=0.598,P<0.001）.（2）There was no significant correlation between the serum INHB at each test time and the follicular CV of that day（P>0.05）.The follicular CV of group 1 at each test time was smaller than that of group 2,showing a trend of better synchronization of follicles,but the difference was not statistically significant（P>0.05）.（3）The serum INHB values for the six detection times and the difference（Δ1）and the proportion（Δ2）of serum INHB decline after pretreatment with estradiol showed positively correlation with the number of retrieved oocytes,the number of MetaphaseⅡoocytes,the number of 2PN fertilization,the number of cleavage and the number of high-quality embryos on the 3^rdday（P<0.05）.what’s more,Δ1 andΔ2 was more closely related to the above mentioned COH indicators.（4）The number of retrieved oocytes,the number of MetaphaseⅡoocytes,the number of 2PN fertilization,the number of cleavage and the number of high-quality embryos on the 3^rdday were significantly higher in the group 1（P<0.05）,but there was no significant difference in the MetaphaseⅡoocytes rate,cleavage rate,and superior embryo rate（P>0.05）.Conclusion:（1）Changes of serum INHB were positively correlated with serum FSH.After the injection of exogenous FSH,serum INHB levels also increased.So INHB can be used as a supplementary indicator for grasping changes in serum FSH levels in the GnRH antagonist protocol.（2）The addition of GnRH antagonist had no significant effect on INHB levels.（3）The detection of serum INHB value can not judge the synchronization of follicles.（4）This study shows that those with a large decrease in serum INHB after pretreatment with estrogen（including the differenceΔ1 and the proportionΔ2）can obtain a better COH outcomes,which means that the decrease of serum INHB after pretreatment with estrogen can be used as one of the better predictive indicators of the retrieved oocytes number,but it has no obvious correlation with the embryonic outcome.