| Objective In vitro fertilization-embryo transfer treatment, the comparativeanalysis of different doses of hCG injection whether impacting for ovulationinduction clinical indicators, laboratory parameters and pregnancy outcomes, ornot. According to the characteristics of the drug and patients for specific situationto screen the lowest effective dose of hCG, for clinical individualized for COH andprovide the basis for the prevention of OHSS.Methods A retrospective analysis of648IVF/ICSI-ET cycles,from January2010to December2012,in reproductive medicine center of Ningxia MedicalUniversity General Hospital for undergoing IVF/ICSI-ET, and the use ofGnRH-a long protocol of ovulation. The patients aged from22to48years old,infertility fixed number of year for the patients is from1to19years, causes ofinfertility in patients include: tubal factor (obstruction, surgical resection),pelvic adhesions, male factor (little, weak, abnormal sperm), unknown cause.Exclusion criteria:1.poor ovarian response,2. hypoovarianism,3. prematureovarian failure.(1) The648cycles is divided into non-PCOS group and PCOSgroup, according to the different injection of hCG dose before ovum pick-updivided into there groups, group A:(8000-10000] IU, group B:(6000-8000] IU,group C:[4000-6000] IU, to research before OPU the comparative analysis ofdifferent doses of hCG injection whether impacting for effect of COH andpregnancy outcomes, or not;(2). Will the non-PCOS group stratified according to age(greater than or equal to35and less than35), to research before OPU thecomparative analysis of different doses of hCG injection whether impacting foreffect of COH and pregnancy outcomes, or not.;(3).On the day of hCG.,E2greaterthan or equal to4000pg/ml and total number oocytes more than15is defined asa high ovarian response in patients, according to the different injection of hCGdose before ovum pick-up divided into there groups, group A:(8000-10000] IU,group B:(6000-8000] IU, group C:[4000-6000] IU, to research before OPU thecomparative analysis of different doses of hCG injection whether impacting foreffect of COH,pregnancy outcomes, OHSS rate,or not.Results1.the overall comparison of the non-PCOS group: The differencebetween three groups of age (P=5.44*10-6), LH on the day of injection hCG.(P=0.007),24hours before OPU the serum of hCG(P=0.004) were statisticallysignificant (P <0.05), group A was higher than that in group B and in groupC; The difference between three groups On the day of hCG injection,the number offollicles about diameter greater than or equal to14mm(P=1.36*10-34),E2on theday of hCG. injection (P=3.86*10-41), E2on the day of OPU(P=2.65*10-11), P onthe day of OPU(P=0.001) were statistically significant (P <0.05), group C washigher than that in group B and in group A; The difference between three groupsof P On the day of hCG injection (P=0.009) was statistically significant (P<0.05),group B was higher than that in group C and in group A; Thedifference between three groups of total number oocytes (P=3.28*10-21), thenumber of MII (P=5.64*10-16), the number of fertilized eggs (P=6.65*10-18), thenumber of cleavage(P=7.49*10-15), the number of high qualityembryos(P=3.01*10-7) were statistically significant (P <0.05),group C was higherthan that in group B and in group A; The difference between three groups ofBMI was not statistically significant (P>0.05); The difference between three groups of oocyte maturation rate, fertilization rate of IVF/ICSI, cleavage rate,clinical pregnancy rate,abortion rate was not statistically significant (P>0.05).2.The non PCOS group stratified by age:(1) aged less than35years old: Thedifference between three groups of age (P=0.003),24hours before OPUthe serum of hCG(P=0.002) were statistically significant (P <0.05), group A washigher than that in group B and in group C; The difference between three groupsOn the day of hCG injection,the number of follicles about diameter greater than orequal to14mm(P=1.92*10-27),E2on the day of hCG. injection (P=4.80*10-31), E2on the day of OPU(P=2.63*10-7), P on the day of OPU(P=0.006) were statisticallysignificant (P <0.05), group C was higher than that in group B and in groupA; The difference between three groups of LH，P On the day of hCG injection，BMI were not statistically significant (P>0.05);The difference between threegroups of total number oocytes (P=8.59*10-16), the number ofMII (P=2.04*10-11), the number of fertilized eggs(P=3.96*10-13), the number ofcleavage (P=1.62*10-10), the number of high quality embryos(P=2.62*10-5) werestatistically significant (P <0.05),group C was higher than that in group B and ingroup A; The difference between three groups of oocyte maturation rate,fertilization rate of IVF/ICSI, cleavage rate, clinical pregnancy rate and abortionrate were not statistically significant (P>0.05).(2) aged greater than or equal to35years old: For A, B, C three groups of sample size is different,the combinationin group B C and D groups, to improve the efficiency of inspection.The differencebetween two groups of E2on the day of hCG. injection (P=3.37*10-11),On the dayof hCG injection,the number of follicles about diameter greater than or equal to14mm(P=1.65*10-5), E2on the day of OPU(4.84*10-12), total number oocytes(P=6.25*10-5), the number of MII (P=2.68*10-5), the number of fertilizedeggs(P=1.19*10-5), the number of cleavage (P=4.28*10-5), the number of high quality embryos(P=0.002) were statistically significant (P<0.05),age(P=0.003),24hours before OPU the serum of hCG(P=0.002) were statistically significant (P<0.05), group D was higher than that in group A;The difference between twogroups of age,BMI,LH,P On the day of hCG injection,24hours before OPUthe serum of hCG,P on the day of OPU were not statistically significant (P>0.05);The difference between two groups of fertilization rate of ICSI was statisticallysignificant(P <0.05); The difference between three groups of oocyte maturationrate, fertilization rate of ICSI, cleavage rate, clinical pregnancy rate and abortionrate were not statistically significant (P>0.05).3.PCOS group:The differencebetween three groups of the number of follicles about diameter greater than orequal to14mm(P=1.02*10-4), E2on the day of hCG. injection (P=2.53*10-7), E2onthe day of OPU(P=4.42*10-6) were statistically significant (P <0.05), group C washigher than that in group B and in group A; The difference between three groupsof total number oocytes (P=0.001), the number of MII (P=0.005), the number offertilized eggs(P=0.011), cleavage rate (P=0.007) were statistically significant (P<0.05), group C was higher than that in group B and in group A; The differencebetween three groups of age, BMI,24hours before OPU the serum of hCG, LH,POn the day of hCG injection， P on the day of OPU,the number of high qualityembryos were not statistically significant (P>0.05);The difference between threegroups of oocyte maturation rate, fertilization rate of IVF/ICSI, cleavage rate,clinical pregnancy rate and abortion rate were not statistically significant (P>0.05).4.The group of high ovarian response: The difference between three groupsof oocyte maturation rate, fertilization rate of IVF/ICSI, cleavage rate,clinical pregnancy rate and abortion rate were not statistically significant (P>0.05).The difference between three groups of the cancellation rate of OHSS（P=0.028） were statistically significant (P <0.05), group A was higher than that in group B and in group C.Conclusion1.In the treatment of IVF-ET, non PCOS patients to reduce thedose of injection hCG did not affect the number of total number oocytes, thenumber of MII, the number of fertilized eggs,the number of cleavage,oocytematuration rate, fertilization rate of IVF/ICSI, cleavage rate, clinical pregnancyrate,abortion rate.2. In the treatment of IVF-ET,PCOS patients to reduce thedose of injection hCG did not affect oocyte maturation rate, fertilization rate ofIVF/ICSI, cleavage rate, clinical pregnancy rate,abortion rate; injected4000IUhCG on36h before OPU, didn’t affect the regnancy outcome.3. In thetreatment of IVF-ET,patients with high ovarian response to reduce the dose ofinjection hCG did not affect oocyte maturation rate, fertilization rate of IVF/ICSI,cleavage rate, clinical pregnancy rate,abortion rate.To reduce the dose of hCGinjections can reduce OHSS cycle cancellation rate. |
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