| Objective:To investigate whether Gn RH-a down-regulation in combination with hormone replacement therapy can improve pregnancy outcomes in patients with tubal infertility alone and those with polycystic ovary syndrome（PCOS）.Also to explore the correlation between the two infertility factors and this endo-preparation protocol,in order to provide a theoretical basis for finding a more economical,convenient and feasible personalized endo-preparation protocol.Methods:By retrospectively analyzing the clinical data of infertility patients treated with frozen-thaw embryo transfer（FET）at the Reproductive Center of the Second Hospital of Jilin University from 2019.01 to 2021.01,we obtained 416 cycles after screening.The study was divided into three parts.In the first part,patients with tubal factor infertility（group A）were divided according to the endo-preparation protocol: half-dose Gn RH-a down-regulation in combination with hormone replacement therapy group（group A0）,full-dose Gn RH-a down-regulation in combination with hormone replacement therapy group（group A1）,hormone replacement group（group A2）,and natural cycle group（group A3）.The four groups were analyzed to compare the baseline conditions such as age,BMI,years of infertility,number of embryos transferred,endometrial thickness on the day of progesterone conversion,and endometrial thickness on the day of transfer,and to compare the pregnancy outcomes such as embryo implantation rate,clinical pregnancy rate,and early miscarriage rate among the four groups.In the second part,patients with PCOS factor infertility（group B）were divided into Gn RH-a down-regulation in combination with hormone replacement therapy group（group B1）and hormone replacement group（group B2）according to the endopreparation protocol.The analysis was compared as described previously.In the third part,FET cycles with the application of Gn RH-a down-regulation in combination with hormone replacement therapy（group C）were divided according to infertility factors:tubal factor group（group C1）and PCOS factor group（group C2）,and the analysis was performed to compare the clinical pregnancy outcomes of the two groups and to analyze the factors associated with the pregnancy outcomes of FET with the application of this endo-preparation protocol.Results:Part 1:The embryo implantation rate was greater in groups A0 and A1 than in group A2（29.9%,34.4% vs.19.4%）,and the clinical pregnancy rate was greater in groups A0 and A1 than in group A3（51.2%,53.8% vs.38.1%）,all with statistically significant differences（P<0.05）.There was no statistically significant difference in the embryo implantation rate and clinical pregnancy rate in groups A0 and A1（P>0.05）.There was no statistically significant difference in the early miscarriage rate in groups A0,A1 and A2（P>0.05）.In the univariate analysis of factors affecting the pregnancy outcome of FET in patients in group A,the differences in BMI,the number of embryos transferred,and the percentage of application of Gn RH-a down-regulation in combination with hormone replacement therapy were statistically significant between the pregnancy and non-pregnancy groups（P<0.05）.The proportion of patients applying Gn RH-a downregulation in combination with hormone replacement therapy was greater in the pregnancy group than in the non-pregnancy group（48.3% vs.30.3%）.Part 2:The embryo implantation rate was greater in group B1 than in group B2（39.5%vs.15.8%）,and the difference was statistically significant（P<0.05）.The clinical pregnancy rate was higher in group B1 than in group B2（38.9% vs.26.8%）,and the difference was not statistically significant（P>0.05）.In the univariate analysis affecting the FET pregnancy outcome of patients in group B,the basic LH values of patients in the pregnancy group were lower than those in the non-pregnancy group（（7.07±4.62）m IU/m L vs（10.45±6.29）m IU/m L）,and the difference was statistically significant（P<0.05）.Part 3:The embryo implantation rate and clinical pregnancy rate were higher in group C1 than in group C2（33.3% vs.26.3%）,（55.8% vs.38.9%）,with statistically significant differences（P<0.05）.The endometrial thickness on the day of progesterone conversion and on the day of transfer were greater in group C1 than in group C2（（11.09±1.68）mm vs.（10.28±1.17）mm,（11.32±2.10）mm vs（10.28±1.24）mm）,with statistically significant differences（P<0.05）.In the univariate analysis affecting the pregnancy outcome of FET in group C patients,the difference in female BMI was statistically significant between the pregnancy and non-pregnancy groups（P<0.05）.Conclusions:1.In patients with tubal factor infertility,the application of Gn RH-a downregulation in combination with hormone replacement therapy helps to improve clinical pregnancy rates and embryo implantation rates.Patients with full-dose Gn RH-a and half-dose Gn RH-a for down regulation have similar pregnancy outcomes.2.In patients with PCOS factor infertility,the application of Gn RH-a downregulation in combination with hormone replacement therapy helps to improve the embryo implantation rate. |
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