The Research Of Progesterone Primed Ovarian Sitmulation On The Patients With Severe Ovarian Endometriosis During IVF-ET

Objective: To investigate the usage of medroxyprogesterone acetate(MPA)or the ultra-long gonadotropin release hormone agonist(Gn RH-a)protocol for controlled ovarian hyperstimulation(COH)in patients with advanced endometriosis who have normal ovarian function,and to compare cycle characteristics and pregnancy outcomes after frozen-thawed embryo transfer(FET).To study inflammatory factors and metabolites profiles of follicular fluid in the two groups.Methods: This was a prospective case-control study of 300 patients with advanced endometriosis who underwent COH.The patients were allocated to two groups: the group with MPA COH and the ultra-long Gn RHa protocol group at Shanghai Ninth People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine during the period from March 2016 to September 2017.Furthermore,to detect levels of inflammatory factors using ELISA and metabolites using metabolomics of follicular fluid in the two groups.To explore the effects of new protocols on follicular immune and metabolic microenvironment in patients with severe endometriosis and to optimize follicular microenvironment and to improve the IVF clinical predictive value of metabolomics.The main outcomes: The number of oocytes retrieved,mature oocytes,ovary response and embryo outcomes were comparable between the MPA+h MG group and the ultra-long Gn RHa protocol group.The rates of OHSS and premature LH surge were similar in the two groups.The rates of implantation,clinical and ongoing pregnancy were similar between the two groups,independent of fresh or frozen ET in the ultra-long Gn RHa protocol group.The levels of inflammatory factors interleukin-1?(IL-1?),regulated on activation,normal T cell expressed and secreted(RANTES),and tumor necrosis factor-?(TNF-?)in follicular fluid were significantly lower in MPA regimen(P<0.05).The arginine concentration in follicular fluid of patients with endometriosis was significantly increased in the progesterone primed ovarian sitmulation(PPOS)group.Conclusions: PPOS can achieve similar embryos and pregnancy outcomes compared to those of the ultra-long regimen in the case of short gonadotrophin(Gn)time,lower dosage,and less side effects.PPOS can reduce the concentrations of inflammatory factors in follicular fluid and improve the microenvironment of follicular development,and can up-regulate the level of arginine in follicular fluid.Arginine may be important through anti-inflammatory and anti-oxidative effects to improve the inflammatory and immune microenvironment of follicle development,thereby improving the potential of oocyte and embryo development.