| Objective: To retrospectively analyze the effect of four different follicular diameters on In Vitro Fertilisation(IVF)embryo outcome in elderly patients with Ovarian Hyporesponsiveness(POR)on the trigger date of Human Chorionic Gonadotropin(HCG).The effect of the outcome of In Vitro Fertilisation(IVF)on the embryonic outcome and the optimal timing of HCG triggering in POR patients of advanced age.Methods:Retrospective analysis of a total of 195 cycles from 05/2019 to 01/2022 treated with In Vitro Fertilisation-Embryo Transfer(IVF-ET)at the Reproduction Center of the People’s Hospital of Ho Chi Minh City,meeting POSEIDON criteria group 4.All cycles were performed using the Progestin Primed Ovarian Stimulation(PPOS)protocol,and the maximum follicular diameter measured by transvaginal ultrasound on the HCG trigger day was divided into 44 cycles for group A(14mm≤follicular diameter < 16 mm);48 cycles for group B(16mm≤follicular diameter≤18 mm)Group C(18mm< follicular diameter≤20mm)58 cycles;Group D(follicular diameter > 20 mm)45 cycles.In general,including age,years of infertility,body mass index(BMI),number of sinus follicles(AFC bilaterally),anti-mullerian hormone(AMH),and basal sex hormone levels(FSH,LH,E2,P)were not statistically different.mean number of eggs obtained,mature egg rate),and embryo laboratory data(total fertilization rate,2PN fertilization rate,2PN egg cleavage rate,available embryo rate,and D3 eugene rate)for the four treatment cycles.To better clarify the effect of follicle diameter on early IVF embryo development(D3),we performed laboratory studies on 398 eggs obtained in the above four treatment cycles,and we regrouped the total number of eggs according to their follicle diameter of origin: 143 eggs in group E(14mm≤follicle diameter <16 mm);124 eggs in group F(16≤follicle diameter≤18 mm);124 eggs in group G(Group G(18mm < follicle diameter≤20 mm)had 76 eggs;Group H(follicle diameter > 20 mm)had55 eggs.The embryo laboratory outcomes(total fertilization rate,2PN fertilization rate,2PN oogenesis rate,usable embryo rate,and D3 eugene rate)were compared among the four groups of eggs.Results:(1)The basic information of the four treatment cycles is shown in Table 5-1.There were no statistical differences(P > 0.05)in age,years of infertility,BMI,AMH,AFC,and basal sex hormone levels(FSH,LH,E2,and P)among the four treatment cycles.(2)The ovulation data of the four treatment cycles are shown in Table 5-2.195 ovulation cycles were included in this study,and a total of 517 follicles were punctured,with a total of 398 eggs obtained and 119 eggs not obtained.In group A,44 cycles,111 follicles were punctured and68 eggs were obtained;in group B,48 cycles,130 follicles were punctured and 118 eggs were obtained;in group C,58 cycles,151 follicles were punctured and 134 eggs were obtained;in group D,45 cycles,125 follicles were punctured and 78 eggs were obtained.The ovulation data of the four treatment cycles are shown in Table 5-2.The number of Gn days in group D was longer than that in group A,and the total number of Gn was also more,and the comparison between groups was statistically different(P < 0.05).The HCG daily E2 values in group B,group C and group D gradually increased with group,but did not have statistical differences(P>0.05);the HCG daily E2 values per follicle in group A were significantly lower than those in group B,group C and group D,and had statistical differences(P<0.05),and the HCG daily E2 values per follicle in group B,group C and group D were >200 pg/ml and gradually increased with group,but did not have statistical difference(P>0.05);the rate of unacquired eggs in groups B and C was significantly lower than that in groups A and D,with statistical difference(P<0.05),and the rate of unacquired eggs in groups B and C was not statistically different(P>0.05);the mean number of eggs acquired in group B was the highest,and the mean number of eggs acquired in groups A and D was less compared with group B,with statistically significant difference(P < 0.05),and the mean number of eggs acquired in group C was not The mean number of eggs obtained in group C was not statistically different(P>0.05);the rate of mature eggs in group A was significantly lower than that in the other three groups(P<0.05).There was no statistically significant difference in LH on HCG day between the four groups(P>0.05).(3)The embryo laboratory data of the four treatment cycles are shown in Table 5-3.the total fertilization rate,2PN fertilization rate,2PN egg cleavage rate,available embryo rate and D3 superior embryo rate were significantly higher in group B than in groups A and D,and the differences were statistically significant(P< 0.05).group B was higher than group C,but not statistically different(P > 0.05).there was no statistically significant comparison between groups A and D(P > 0.05).(4)The laboratory data of the four groups of egg embryos are shown in Table 5-4.the total fertilization rate,2PN fertilization rate,2PN oogenesis rate,usable embryo rate and D3 superior embryo rate in group F were significantly higher than those in groups E and H,and the differences were statistically significant(P < 0.05).group F was higher than group G,but not statistically different(P > 0.05).there was no statistically significant comparison between groups E and H(P > 0.05).Conclusion: In POR senior patients with follicle diameter of 16-18 mm in PPOS regimen and HCG trigger injection at E2 level >200 pg/ml per follicle,more mature high-quality oocytes were obtained,and the 2PN fertilization rate,2PN oocyte cleavage rate,available embryo rate and D3 superior embryo rate were the highest,which can be used as the main indicator to determine the timing of controlled ovulation HCG injection in POR senior patients in PPOS regimen. |
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