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1 35 1 Vol.35 No Jan Reproduction & Contraception doi: /j.issn X randc_journal@163.com IVF/ICSI-ET ( ) : () / - (IVF/ICSI-ET) : 228 IVF/ICSI hcg Gn ; A B ( ) C D ( ); A C A1 ( <50%) A2 ( 50%) C1 ( <50%) C2 ( 50%) IVF/ICS-ET : (P) (26.09% vs 35.22% P<0.05) (45.11% vs 58.67% P<0.05) (26.08% vs 15.91%) (P) A B C D IVF/ICSI A1 A2 A1 (65.48% vs 40.68% P<0.05); C1 C2 IVF/ICSI : IVF/ICSI-ET hcg Gn <50% : / - (IVF/ICSI-ET); (); () ; (hcg) : R R711.6 : A : X(2015) / - (IVF/ICSI-ET) (controlled ovarian hyperstimulation ) : ; Tel: ; shengzhizhongxin@126.com IVF [1] IVF-ET Gn hcg IVF-ET [2] 30

2 [3] IVF/ICSI hcg Gn IVF-ET ~ IVF/ICSI : <35 FSH 10 IU/L 10 IU/L; (PCOS) (EMs) ; 1.2 hcg Gn ; A B ( ) C D ( ); A C A1 ( <50%) A2 ( 50%) C1 ( <50%) C 2 ( 50%) 1.3 IVF/ICSI ( ; -35 ) 17 B 1 GnRH-a( 3.75 mg/ - )1.25~1.88 mg 14 d FSH E2 FSH< 5 IU/L <5 IU/L E2<50 ng/l B <9 mm <5 mm r-fsh(gonal-f 75 U/ ) 150~225 U/d E2 FSH Gn hmg 75 IU(75 IU/ ) r-fsh 75 IU 2 18 mm (hcg IU/ )8 000~ IU 36 h B 72 h ET 14 d β-hcg β-hcg>5 IU/L 35 d (PN) 2PN = / 100%; 48 h 2- = / 100%; 4 Dale [4] I~II < 30% ; I~III d 7 8 hcg 3 ml E2 P ( <5%) 1.5 SPSS17.0 (x s) (%) χ 2 P< IVF (P); Gn hcg ; (P); ( 1 2) 2.2 IVF A B ; C D Gn hmg 31

3 1 (x s %) Table 1 The clinical characteristics Decreased Increased P Item tendency group tendency group Cycle ( ) Age (year) (a) Duration of infertility Causes (%) 54.9 (84/153) 60.0 (45/75) Pelvic and tubal factor PCOS EMs 5.9 (9/153) 4.6 (7/153) 30.7 (47/153) 5.3 (4/75) 4.0 (3/75) 24.0 (18/75) Male factor 3.9 (6/153) 6.7 (5/75) Unexplained FSH Basal FSH (IU/L) Basal (IU/L) E2 (IU/L) P (IU/L) ( 3 4) Basal Basal AFC (n) After down-regulation FSH (IU/L) (IU/L) Gn <0.05 ( 75 IU/ )No. of Gn ampoules (75 IU/ampoule) hmg ( 75IU/ ) No. of hmg ampoules (75 IU/ampoule) Gn (d) Gn used days hcg On the day of hcg injection IVF A 1 A 2 <0.05 (P> 0.05) A1 A2 (65.48% vs 40.68% P<0.05) ; C1 C2 IVF IVF/ICSI-ET (x s %) Table 2 The clinical outcomes Decreased Increased Index tendency group tendency group P Cycle (n) No. of oocyte retrieved (1 041/1 568) (470/683) Fertility rate (875/1 041) (383/470) Available embryo rate (660/1 041) (278/470) High-quality embryo rate (84/322) (56/159) <0.05 Implantation rate (69/153) (44/75) <0.05 Clinical pregnancy rate (18/69) (7/44) Early abortion rate 3 (assisted reproductive technology ART) Gn hcg IVF >10 mm 7~8 hmg r hcg Gn hcg 3 Gn hcg Gn Gn hcg ; (A ) (B [5] 32

4 3 4 (x s) Table 3 The clinical characteristics among 4 groups Increased tendency group Decreased tendency group Item A Group A B Group B C Group C D Group D ( )Age (year) (a) Duration of infertility FSH (IU/L) Basal FSH (IU/L) Basal Basal E Basal AFC (n) After down-regulation FSH (IU/L) (IU/L) E2 (pg/ml) (IU/L) * # Mid-follicular phase Gn ( 75 IU/ ) # No. of Gn ampoules (75 IU/ampoule) hmg ( 75 IU/ ) # No. of hmg ampoules (75 IU/ampoule) Gn Gn used days (d) hcg On the day of hcg injection (IU/L) P (IU/L) *: P<0.05 A compared with group A #: P<0.05 C compared with group C 4 4 IVF/ICSI-ET (x s%) Table 4 The comparison of clinical outcomes among 4 groups Increased tendency group Decreased tendency group Index A Group A B Group B C Group C D Group D (n) No. of oocyte retrieved Fertility rate Available embryo rate High-quality embryo rate Implantation rate Clinical pregnancy rate Early abortion rate (230/320) (188/227) (134/227) (27/78) (20/36) (4/20) (246/363) (194/243) (144/243) (29/81) (24/39) (3/24) (901/1 337) (740/890) (559/890) (71/272) (58/129) (16/58) (158/231) (135/151) (101/151) (13/50) (11/24) (2/11) ) ( 48% ); (C ) (D ) ( 84% ) Gn 72%(165/228) (A 36+C 129=165 ); Gn hcg 83%(189/228) (A 36+C D 153=189 ); 57% (C 129/228) 33

5 5 (x s) Table 5 The clinical characteristics of patients in decreased group A Group A C Group C Item A1 (<50%) A2 ( 50%) C1 (<50%) C2 ( 50%) ( )Age (year) (a) Duration of infertility FSH Basal FSH (IU/L) Basal (IU/L) E2 Basal Basal AFC (n) After down-regulation FSH (IU/L) (IU/L) # (IU/L) * # Mid-follicular phase Gn ( 75 IU/ ) No. of Gn ampoules (75 IU/ampoule) hmg ( 75 IU/ ) No. of hmg ampoules (75 IU/ampoule) Gn Gn used days (d) hcg On the day of hcg injection (IU/L) P (IU/L) * *: P<0.05 A1 compared with group A1 #: P<0.05 C1 compared with group C IVF/ICSI-ET (x s%) Table 6 The clinical outcomes of patients in decreased group A Group A C Group C Index A1 (<50%) A2 ( 50%) C1 (<50%) C2 ( 50%) (n) No. of oocyte retrieved Fertility rate Available embryo rate High-quality embryo rate Implantation rate Clinical pregnancy rate (170/229) (143/168) (110/168) (20/59) (14/27) (2/14) Early abortion rate *: P<0.05 A1 compared with group A (60/91) (46/59) (24/59) * (7/19) ( 6/9) (1/6) (663/985) (537/655) (399/655) (50/194) (41/92) (12/41) (238/352) (203/235) (160/235) (21/78) (17/37) (4/17)

6 Gn hmg [5] 7~8 hmg r hcg GnRH-a 14 FSH E2 hmg hcg Garcia- Velascod 2000 [6] GnRH-a GnRH-a Sungurtekin [7] GnRH-a 5 d Janssens [8] (GnRH-a)3.75 mg ng/ml 50~60 d 0.1 ng/ml 1/2 14 GnRH-a 0.1 ng/ml 40 d GnRH-a Gn ; Gn hcg 3 (A ) (B ) (C ) (D ) : 14 ( IU/L vs IU/L P<0.05) hcg ; hcg ( IU/L vs IU/L P<0.05) Gn hcg (B ) B>A>D>C Gn B [9-12] E 2 P A B C D Nakagama 2008 [13] / <1 FSH [14] A~D ( IU/L) 2006 Lahoud [15] <50% (A C ) A <50% 35

7 (A1 ) 50% (A2 ) (65.48% vs 40.68%) ; C <50% (C1 ) 50% (C2 ) (60.92% vs 68.09%) ; Lahoud [15] Gn [1] Yung EH Yeung WS Yee Lan Lau E et al. High serum oestradiol concentrations in fresh IVF cycles do not impair implantation and pregnancy rates in subsequent frozen-thawed embryo transfer cycles. Hum Reprod (2): [2] Hu L Bu Z Wang K et al. Recombinant luteinizing hormone priming in early follicular phase for women undergoing in vitro fertilization: systematic review and meta-analysis. J Int Med Res (2): [3] (4): [4] Dale B Elder K. In vitro Fertilization. Cambridge: Cambridge University Press 1997: [5] (9): [6] Garcia-Velasco JA Isaza V Requena A et al. High doses of gonadotrophins combined with stop versus non-stop protocol of GnRH analogue administration in low responder IVF patients: a prospective randomized controlled trial. Hum Reprod (11): [7] Sungurtekin U Jansen RP. Profound luteinizing hormone suppression after stopping the gonadotropin-releasing hormone-agonist leuprolide acetate. Fertil Steril (3): [8] Janssens RM Lambalk CB Vermeiden JP et al. Dose-finding study of triptorelin acetate for prevention of a premature surge in IVF: a prospective randomized double-blind placebo-controlled study. Hum Reprod (11): [9] Tesarik J Hasnt A Menorah C. Luteinizing hormone affects uterine receptivity independently of ovarian function. Report Become Online (1): [10]. IVF (2): [11] Bjuresten K Landgren BM Hovatta O et al. Luteal phase progesterone increases live birth rate after frozen embryo transfer. Fertil Steril (2): [12]. FSH/ (7): [13] Nakagawa K Ohgi S Nakashim A et al. The ratio of latefollicular to mid-follicular phase concentrations efficiently predicts ART outcomes inwomen undergoing ART treatment with GnRH-agonist long protocol and stimulation with recombinant FSH. J Assist Reprod Genet (8): [14] Lisi F Caserta D Montanino M et al. Recombinant luteinizing hormone priming in multiple follicular stimulation for invitro fertilization in down regulated patients. Gynecol Endocrinol (9): [15] Lahoud R Al-Jefout M Tyler J et al. A relative reduction in mid-follicular concentrations during GnRH agonist IVF/ ICSI cycles leads to lower live birth rates. Hum Reprod (10): ( ) ( 52 refer to p52) 36

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