| Objective:In this article,it analysis factors with the results in pregnancy,which in vitro fertilization-embryo transfer or intracytoplasmic sperm microinjection help,based on the analysis of several commonly dose of Gn RH-a in Modified Ultra-long Protocol,by retrospective analysis.We also discussed the clinical value of the Modified Ultra-long Protocol in the patients with normal ovarian reserve function,the optimal dosage,and the effect on the re-treatment after the failure of in vitro fertilization and embryo transfer in the patients.To find a more suitable ovulation induction scheme in the repeated cycles with normal ovarian function.Methods:The infertility patients were selected,who assisted by the Modified Ultra-long Protocol or the Follicular Length Protocol in Reproductive Medicine Center of the Affiliated Hospital of Gui Lin Medical College from January 2017 to January2019,in total of 74 cases.We should record the information including clinical basic data,regulation,promotion,laboratory and clinical outcomes,etc.Also,four groups divided according to the different dose of Gn RH-a,were used for statistical analysis.Results:1.By comparing the data among the four groups,we can see that BMI before assisted pregnancy was the lowest in group of Modified Ultra-long Protocol 1.5-1.0～1.2mg was statistically significant（P<0.05）.2.There were no cases cancel the cycle due to hypophysis inhibition being too deep or insufficient.Compared endometrium thickness,FSH,LH,E2 hormone levels in date of Gn start,and time of Lower Adjustment,the results were statistically significant（P>0.05）.However,there were4 cases didn,t reach the Lower Adjustment Standard in group of Modified Ultra-long Protocol 1.875-1.5mg,and 3 cases were extended the time of Second Period Lower Adjustment >18 days considering deep Lower Adjustment（follicle≤2-3mm）.There were 3 cases didn,t reach the Lower Adjustment Standard in group of Modified Ultra-long Protocol 1.875-1.875 mg,and 3 cases were extended the time of Second Period Lower Adjustment >18 days.ALL of cases reach the Lower Adjustment Standard in group of Modified Ultra-long Protocol 1.5-1.0～1.2mg,and no cases were extended the time of Second Period Lower Adjustment >18 days.In the end,there were 2 cases didn,t reach the Lower Adjustment Standard in group of Follicular Length Protocol 3.75 mg.3.As shown in Table 3,the LH level in triggering day of Follicular Length Protocol 3.75 mg group was significantly lower than Modified Ultra-long Protocol,compared with Modified Ultra-long Protocol1.875-1.5mg the difference was statistically significant（P<0.05）,but improved.There was no significant between the three groups in Modified Ultra-long Protocol（P>0.05）.There were no significant P level and endometrial thickness in triggering day and Gn duration and total in the 4 groups（P>0.05）.4.As shown in Table 4,there was no significant in the number of embryos,abortion rate,ectopic pregnancy rate and OHSS rate between the four groups（P>0.05）.The number of embryos in the Follicular Length Protocol 3.75 mg group were higher than Modified Ultra-long Protocol,and the difference compared with groups of Modified Ultra-long Protocol 1.875-1.5mg and Modified Ultra-long Protocol 1.5-1.0～1.2mg had statistically significantgroup.But the rate of excellent embryos in groups of Modified Ultra-long Protocol were more than group of Follicular Length Protocol3.75 mg,especially in groups of Modified Ultra-long Protocol1.875-1.5mg（P<0.05）.The HCG positive rate and clinical pregnancy rate in group Modified Ultra-long Protocol 1.875-1.5mg group were significantly from the other groups（P<0.05）.Conclusions:1.On the premise of not affecting the pregnancy outcome of the patients,the BMI is proportional to the Gn RH-a lowering adjustment dose.The lower BMI,the less gonadotropin lowering adjustment dose is required.2.The Lower Adjustment Standard can be achieved by half dose of Gn RH-a,but Modified Ultra-long Protocol 1.875-1.875 mg group may result deep Lower Adjustment.3.Compared with the other two groups,the high quality embryo rate,the positive rate of HCG and the clinical pregnancy rate were increased in Modified Ultra-long Protocol 1.875-1.5mg group,but the risk of abortion rate OHSS was not increased.It was suitable for most infertile patients with normal ovarian reserve function.4.Compared with group Follicular Length Protocol 3.75 mg,Modified Ultra-long Protocol group could improve the quality of spawn cell and the rate of optimum embryo,has better improvement on endometrial receptivity.The effect of Modified Ultra-long Protocol 1.875-1.5mg group was the most.In patients with normal ovarian reserve function who had failed to assist with IVF or ICSI in the past,could try Modified Ultra-long Protocol during repeated cycles. |
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