| Objective :To explore the effect of h CG in luteal phase support on the pregnancy outcome of IVF / ICSI-ET cycles,so as to provide theoretical basis for clinical work.Methods:Through screening of infertile patients who were treated at the Reproductive Center of the Second Hospital of Jilin University from 2017.09 to 2019.09,and were assisted by IVF-ET,929 cycles were finally counted.This study is divided into two parts:Part 1:Modified long down-regulation protocol group in fresh embryo transfer cycle(Group A);Part 2(Frozen embryo transfer cycle group):according to different regular endometrial preparation protocol,it divided into:natural cycle-frozen embryo transfer group(group B)and hormone replacement therapy-frozen embryo transfer group(group C).And then according to the different luteal support schemes,the three groups A,B,and C were respectively divided into two subgroups,the h CG luteal support group and the conventional luteal support group.Compare the age,BMI,AFC and other basic conditions of the patients in each subgroup of three groups,LH level on h CG day,E2 level on h CG day,P level on h CG day,endometrial thickness on h CG day,number of oocytes obtained,and rate of high-quality embryos and other super-ovulation and laboratory outcomes,as well as clinical pregnancy outcomes such as embryo implantation rate,early pregnancy miscarriage rate,gestational week of delivery,number of fetuses delivered,delivery method,etc.Finally,patients in groups A,B,and C were respectively divided into clinical pregnancy group and non-pregnant group according to whether they were pregnant or not,and logistic regression analysis was performed to explore the key factors affecting the outcome.Results:Part 1:Comparison of h CG corpus luteum support group and conventional corpus luteum support group in group A: The fertilization rate and 2PN fertilization rate of patients in the h CG group were higher than those in the no h CG group(85.30% VS82.51%,84.87% VS 81.19%),and there were statistical differences(P=0.047,0.01<0.05).The clinical pregnancy rate in the h CG group was higher than that in the no h CG group(56.82% VS 46.34%),and there was a statistical difference(P=0.034<0.05).However,two groups of patients in age,BMI,AFC,the levels of LH,E2,P and endometrial thickness on the h CG day,number of oocytes retrieved,embryo implantation rate,abortion rate of early pregnancy were compared,and there was no statistical significance(P>0.05).Logistic regression analysis in the group A:The high quality embryo rate(OR=2.125,95%CI[1.190-3.795],P<0.05)had significant effect on the clinical pregnancy rate.The increase of the number of high-quality embryos is an independent protective factor that affects the clinical pregnancy of patients with long-plan fresh embryo cycle transfer.After excluding confounding factors,it was found that the addition of h CG was an independent factor affecting the pregnancy outcome of patients with natural cycle FET(OR=1.624,95%CI [1.090-2.418],P < 0.05).Compared with the group with no h CG,the clinical pregnancy rate in the h CG group increased by 62.4%.Part 2:1.The clinical pregnancy rate of HCG group was higher than that of the group without HCG(53.48% VS 29.41%),and the difference was statistically significant(P=0.034<0.05).The abortion rate of early pregnancy in the group with HCG supplementation was lower than that without HCG supplementation(4.3% VS 30%),with statistical difference(P=0.038 < 0.05).However,two groups of patients in age,BMI,AFC,embryo implantation rate were compared,and there was no statistical significance(P>0.05).Logistic regression analysis in the group B:Endometrial thickness on the h CG day(OR=1.642,95%CI[1.137-2.373],P < 0.05),the number of embryo implantation(OR=5.947,95%CI[1.625-21.763],P < 0.05)had significant effect on the clinical pregnancy rate.The increase of the number of transplants and the thickening of the endometrium on the day of transplantation are independent protective factors that affect the clinical pregnancy outcome of patients with natural cycle FET.After excluding confounding factors,it was found that the addition of h CG was an independent factor affecting the pregnancy outcome of patients with natural cycle FET,which could significantly increase their clinical pregnancy rate(OR=0.003,95%CI[2.226-56.461],P<0.05).2.Comparison of h CG corpus luteum support group and conventional corpus luteum support group in the group C: The embryo implantation rate in the h CG-added group was significantly higher than that in the non-h CG group(33.2% VS 18.7%),and there was a statistical difference(P=0.00<0.05).However,two groups of patients in age,BMI,AFC,abortion rate of early pregnancy were compared,and there was no statistical significance(P>0.05).Logistic regression analysis in the group C:The number of embryo implantation(OR=2.861,95%CI[1.763-4.642],P < 0.05)had significant effect on the clinical pregnancy rate.The increase of the number of transplants are independent protective factors that affect the clinical pregnancy outcome of patients with natural cycle FET.After excluding confounding factors,whether to add h CG for luteum phase support after the long-term fresh embryo cycle transplantation could not increase the clinical pregnancy rate(OR=0.651,95%CI[0.393-1.079],P>0.05).Conclusion:1.For fresh embryo transplantation patients after Gn RH-a down-regulation,the application of HCG in luteum support can significantly improve the clinical pregnancy rate,and the increase of high-quality embryo number is an independent protective factor affecting clinical pregnancy during the fresh embryo transfer cycle of the modified long regimen.2.For patients with NC-FET,the application of HCG in luteal support can improve the clinical pregnancy rate and reduce the early abortion rate.The increase of the number of transplants and the intimal thickness on the transplantation day are independent protective factors affecting the clinical pregnancy outcome of NC-FET.3.For patients with HRT-FET,the use of HCG in luteal support does not improve clinical pregnancy outcomes. |
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