Application Analysis Of Different Ovulation Induction Schemes In Patients With Endometriosis

Background and ObjectivesEndometriosis（EMS）is relatively common in women of reproductive age,and the incidence of Endometriosis in infertile women is 6-8 times higher than that in women of general reproductive age.The reasons for infertility caused by endometriosis are complex and varied.For patients with endometriosis combined with infertility,the best time to get pregnant is within 1 year after laparoscopy.In order to get pregnant as soon as possible,more and more EMS patients choose human assisted reproductive technology（ART）for pregnancy.The key to successful ART-assisted pregnancy is to obtain sufficient number of mature oocytes,while EMS patients with ectopic implanted endometrium cause excessive activation of the immune system,resulting in immune abnormalities in the local pelvic environment,often resulting in reduced egg quality,sperm-egg combination disorders,embryo quality and poor endometrium receptivity,leading to infertility.With the development of ART technology,there are more and more options for controlled ovarian stimulation（COS）.For EMS patients,it is particularly important to individualize the short-duration and effective regimen.This study retrospectively analyzed the EMS patients with infertility who received ART assisted pregnancy in our center,and divided them into three groups according to different ovulation induction programs:the long-acting and long-acting program in the follicular phase,the short-acting and long-acting program in the luteal phase,and the long-acting and long-acting program in the follicular phase.The laboratory and clinical indexes after treatment were compared to explore the best treatment program for such patients.Materials and Methods1.Research objectA total of 434 EMS women with infertility who received ART assisted pregnancy in our center from January 2015 to August 2020 were selected.All the patients were diagnosed with endometriosis by uterine laparoscopic surgery and/or pathological examination before ART treatment.All patients met the indications of assisted pregnancy,and no obvious abnormalities were found in routine examination before ART assisted pregnancy.2.Grouping methodStimulate ovulation scheme is divided into 3 groups,group A for follicular phase long-term long plan（166 eggs cycle,69 freeze-thaw embryos recovery period）and group B as super long scheme（122 eggs cycle,85 freeze-thaw embryos recovery period）,group C for luteal phase short-acting long scheme（167 eggs cycle,113freeze-thaw embryos recovery period）.3.Statistical methodThe data were processed by SPSS21.0 statistical software package.Measurement data conforming to normal distribution were expressed as Mean±standard deviation（Mean±SD）.One-way ANOVA was used for comparison among groups.LSD method was used for homogeneity of variances,and Tamhanes’T2method was used for inhomogeneity of variances.Measurement data that did not conform to normal distribution were expressed as M（P25,P75）,and non-parametric Kruskal-Wallis H test was used for comparison between groups.Enumeration data were expressed as rate（%）,andχ²test was used for comparison between groups.Pwas considered statistically significant.Results1.There were no statistically significant differences in age,infertility years,BMI,AFC,AMH,serum BFSH,and basal E₂（P>0.05）.There was no statistical significance in the proportion of patients with different stages of AFS in each group（P>0.05）.2.Comparison of ovulation induction indexes:the total amount and days of Gn use in group B（3202.54±1051.43,12.42±2.87）were significantly higher than those in the other two groups,followed by group A（2902.40±761.33,11.53±1.93）,and group C（2571.11±692.02,10.35±2.03）.Pair comparison among the three groups showed statistically significant difference（P<0.05）.The E2 level of group B（2948.04±1865.82）on HCG day was significantly lower than that of the other two groups,and the difference was statistically significant（P<0.05）.The E2 level of group A（3416.54±2652.96）was slightly lower than that of group C（3330.94±2175.72）,and the difference was not statistically significant（P>0.05）.The level of LH in group C（2.19±1.02）on HCG day was significantly higher than that in group A（1.20±0.83）and group B（1.19±0.70）,and the difference was statistically significant（P<0.05）.The level of LH in group A and group B was similar,but the difference was not statistically significant（P>0.05）.The number of eggs obtained in group A（11.13±5.92）was significantly higher than that in group C（9.53±5.78）,the difference was statistically significant（P<0.05）,and that in group A was slightly higher than that in group B（10.83±5.83）,but the difference was not statistically significant（P>0.05）.3.Laboratory indexes comparison:MⅡegg number,2 pn cleavage in group C（8.04±4.65,5.75±4.04）was significantly lower than group A（6.65±9.66,5.31±3.81）and group B（7.00±9.75,5.42±4.25）,the difference was statistically significant（P<0.05）,group A is slightly lower than that of group B,there was no statistically significant difference（P>0.05）;The fertilization rate of group B（82.0%）was significantly higher than that of group C（77.4%）and group A（78.2%）,and the difference was statistically significant（P<0.05）.The fertilization rate of group C was similar to that of group A,but there was no statistical significance（P>0.05）.There was no significant difference in the number of excellent embryos,number of available embryos,cleavage rate and rate of high-quality embryos among the three groups（P>0.05）.4.Comparison of cancellation of transplantation in fresh egg collection cycle:the cancellation rate of transplantation in group A（22.8%）was significantly lower than that in group C（33.7%）and group B（41.8%）,and the difference was statistically significant（P<0.05）.There was no statistical difference in reasons for cancellation of transplantation among the 3 groups（P>0.05）.5.Comparison of assisted pregnancies:compared with the clinical pregnancy rate,embryo implantation rate and live birth rate in fresh cycle and resuscitation cycle,the trend of group A was higher than that of group B and C,but there was no statistical significance among the three groups（P>0.05）.The abortion rate of group A was lower than that of the other two groups,but there was no significant difference between the three groups（P>0.05）.Comparison of cumulative pregnancy rate and cumulative live birth rate,group A>group B>group C,but there was no statistical difference between the three groups（P>0.05）.Conclusions1.The optimal number of eggs obtained and embryos available was obtained by the long-effect and long-duration scheme in follicular stage,and the embryo implantation rate,cumulative pregnancy rate and cumulative live birth rate were the highest in the three groups.2.The time cost and economic cost of patients in the ultra-long regimen increased.Although the fertilization rate and embryo quality were improved,the embryo implantation rate,cumulative pregnancy rate and cumulative live birth rate were lower than those in the long-effect and long-duration regimen group in the follicular period,possibly due to the partial damage of endometrial function.3.The luteal phase short-acting and long-acting regimen had the advantages of small dosage and short duration of medication,but the number of eggs obtained,cumulative pregnancy rate and cumulative live birth rate were lower than those of the long-acting and long-acting regimen in follicular phase.