IVF/ICSI-ET (,, )

35 1 Vol.35 No.1 2015 1 Jan. 2015 Reproduction & Contraception doi: 10.7669/j.issn.0253-357X.2015.01.0030 E-mail: randc_journal@163.com IVF/ICSI-ET ( 230601) : () / - (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) : R714.12 R711.6 : A : 0253-357X(2015)01-0030-07 / - (IVF/ICSI-ET) (controlled ovarian hyperstimulation ) : ; Tel: +86-13705697045; E-mail: shengzhizhongxin@126.com IVF [1] IVF-ET Gn hcg IVF-ET [2] 30

[3] IVF/ICSI hcg Gn IVF-ET 1 1.1 2013.05~2013.08 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 5 000 IU/ )8 000~10 000 IU 36 h B 72 h ET 14 d β-hcg β-hcg>5 IU/L 35 d 1.4 1.4.1 2 (PN) 2PN = / 100%; 48 h 2- = / 100%; 4 Dale [4] I~II < 30% ; I~III 1.4.2 14 d 7 8 hcg 3 ml E2 P ( <5%) 1.5 SPSS17.0 (x s) (%) χ 2 P<0.05 2 2.1 IVF (P); Gn hcg ; (P); ( 1 2) 2.2 IVF A B ; C D Gn hmg 31

1 (x s %) Table 1 The clinical characteristics Decreased Increased P Item tendency group tendency group Cycle 153 75 ( ) 31.3 4.5 32.2 4.5 Age (year) (a) 5.4 5.2 5.33 3.15 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 8.35 2.12 8.39 2.64 Basal FSH (IU/L) Basal (IU/L) 4.86 2.60 4.79 4.94 E2 (IU/L) P (IU/L) ( 3 4) 55.32 34.99 50.96 26.14 Basal 14.1 6.1 13.6 6.4 Basal AFC (n) After down-regulation FSH (IU/L) (IU/L) Gn 3.29 1.53 15.36 38.5 1.68 0.78 10.95 12.2 3.67 1.10 18.01 37.3 1.76 1.01 12.79 12.1 <0.05 ( 75 IU/ )No. of Gn ampoules (75 IU/ampoule) hmg 9.8 7.3 11.0 8.9 ( 75IU/ ) No. of hmg ampoules (75 IU/ampoule) Gn (d) 15.0 2.9 14.5 2.9 Gn used days hcg On the day of hcg injection 0.78 0.44 3 298 1 378 1.20 0.75 1.99 1.99 3 384 1 484 1.11 0.53 2.3 IVF A 1 A 2 <0.05 (P> 0.05) A1 A2 (65.48% vs 40.68% P<0.05) ; C1 C2 IVF 5 6 2 IVF/ICSI-ET (x s %) Table 2 The clinical outcomes Decreased Increased Index tendency group tendency group P Cycle 153 75 (n) 10.2 4.6 9.1 4.2 No. of oocyte retrieved 66.39 (1 041/1 568) 68.81 (470/683) Fertility rate 84.05 (875/1 041) 81.49 (383/470) Available embryo rate 63.40 (660/1 041) 59.19 (278/470) High-quality embryo rate 26.09 (84/322) 35.22 (56/159) <0.05 Implantation rate 45.11 (69/153) 58.67 (44/75) <0.05 Clinical pregnancy rate 26.08 (18/69) 15.91 (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

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 36 39 129 24 ( )Age (year) 31.7 4.5 32.7 4.4 31.6 4.6 29.5 3.8 (a) 5.2 3.9 4.9 3.6 5.7 5.4 5.0 3.7 Duration of infertility FSH (IU/L) Basal FSH 8.51 3.21 8.29 1.99 8.41 2.16 8.01 1.93 (IU/L) Basal 5.53 6.50 4.10 2.68 4.75 2.41 5.44 3.47 Basal E2 51.38 21.43 50.58 25.24 56.69 36.31 47.96 26.34 Basal AFC (n) 12.9 6.4 14.2 6.4 13.6 5.7 16.8 7.8 After down-regulation FSH (IU/L) 3.84 1.88 3.53 1.67 3.62 1.68 3.68 1.65 (IU/L) 1.20 1.25 1.02 0.73 1.53 0.72 1.60 1.06 E2 (pg/ml) 16.92 10.45 19.02 14.65 15.04 10.51 17.05 13.19 (IU/L) 0.71 0.45 2.32 2.08 * 0.89 0.46 2.64 2.08 # Mid-follicular phase Gn ( 75 IU/ ) 36.2 10.6 38.4 13.3 40.1 11.9 30.3 10.1 # No. of Gn ampoules (75 IU/ampoule) hmg ( 75 IU/ ) 10.19 8.64 11.72 9.26 9.37 7.24 6.02 6.88 # No. of hmg ampoules (75 IU/ampoule) Gn Gn used days (d) 13.3 3.0 13.7 2.7 15.0 2.7 15.2 3.7 hcg On the day of hcg injection (IU/L) 2.08 2.40 1.92 1.49 0.76 0.39 0.93 0.63 3 419.09 1 519.66 3 350.69 1 469.61 3 317.65 1 392.91 3 189.88 1 317.69 P (IU/L) 1.12 0.60 1.09 0.47 1.18 0.69 1.33 0.99 *: 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 36 39 129 24 (n) No. of oocyte retrieved 8.9 3.7 9.3 4.6 10.3 4.6 9.6 5.0 Fertility rate Available embryo rate High-quality embryo rate Implantation rate Clinical pregnancy rate Early abortion rate 71.87 (230/320) 83.26 (188/227) 59.03 (134/227) 34.62 (27/78) 55.50 (20/36) 20.00 (4/20) 67.77 (246/363) 79.84 (194/243) 59.26 (144/243) 35.80 (29/81) 61.54 (24/39) 12.50 (3/24) 67.39 (901/1 337) 83.15 (740/890) 62.81 (559/890) 26.10 (71/272) 44.96 (58/129) 27.58 (16/58) 68.39 (158/231) 89.40 (135/151) 66.89 (101/151) 26.00 (13/50) 45.83 (11/24) 18.18 (2/11) ) ( 48% 36 39 ); (C ) (D ) ( 84% 129 24 ) 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 (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) 27 31.7 4.7 4.9 3.8 8.04 2.25 5.83 7.31 54.92 29.04 12.8 6.7 9 31.7 4.0 5.8 4.1 8.87 5.06 4.62 3.15 41.18 20.13 13.1 5.6 92 31.2 4.5 5.4 5.3 8.36 2.05 4.83 2.46 55.49 38.19 13.5 5.8 37 32.5 4.7 6.4 5.6 8.54 2.42 4.56 2.28 59.65 31.54 13.8 5.9 After down-regulation FSH (IU/L) (IU/L) 4.11 1.05 17.01 1.96 0.52 11.07 3.04 1.65 16.65 1.39 2.37 8.93 2.91 1.44 14.12 1.66 0.64 9.97 2.83 1.74 17.34 1.65 0.85 # 11.57 (IU/L) 0.79 0.40 0.48 0.52 * 1.02 0.47 0.59 0.27 # Mid-follicular phase Gn ( 75 IU/ ) 35.4 9.6 38.5 13.5 39.4 11.4 41.9 13.1 No. of Gn ampoules (75 IU/ampoule) hmg ( 75 IU/ ) 10.2 9.6 10.3 5.4 9.3 7.8 9.7 5.6 No. of hmg ampoules (75 IU/ampoule) Gn Gn used days (d) 13.2 3.3 13.7 1.9 14.8 2.3 15.7 3.5 hcg On the day of hcg injection (IU/L) P (IU/L) 1.78 3 539.58 1.13 1.01 1 483.96 0.63 2.96 3 057.66 1.08 4.55 * 1 658.46 0.53 0.79 3 486.48 1.14 0.39 1 373.29 0.57 0.68 2 897.87 1.26 0.38 1 370.13 0.95 *: P<0.05 A1 compared with group A1 #: P<0.05 C1 compared with group C1 34 6 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 27 8.5 3.8 74.24 (170/229) 85.12 (143/168) 65.48 (110/168) 33.89 (20/59) 58.33 (14/27) 14.27 (2/14) Early abortion rate *: P<0.05 A1 compared with group A1 9 10.1 3.3 65.93 (60/91) 77.97 (46/59) 40.68 (24/59) * 36.84 (7/19) 66.67 ( 6/9) 16.67 (1/6) 92 10.6 4.7 67.31 (663/985) 81.98 (537/655) 60.92 (399/655) 25.77 (50/194) 44.57 (41/92) 29.27 (12/41) 37 9.5 4.4 67.62 (238/352) 86.38 (203/235) 68.09 (160/235) 26.92 (21/78) 45.95 (17/37) 23.53 (4/17)

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 4 0.23 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 (1.53 0.78 IU/L vs 1.10 1.01 IU/L P<0.05) 153 24 129 hcg ; hcg (0.78 0.44 IU/L vs 1.99 1.99 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 ( 0.71 0.45 IU/L) 2006 Lahoud [15] <50% (A C ) A <50% 35

(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 2000 15(2):250-5. [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 2014 42(2):261-9. [3].. 2012 32(4):237-40. [4] Dale B Elder K. In vitro Fertilization. Cambridge: Cambridge University Press 1997:115-6. [5].. 2014 23(9):716-9. [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 2000 15(11):2292-6. [7] Sungurtekin U Jansen RP. Profound luteinizing hormone suppression after stopping the gonadotropin-releasing hormone-agonist leuprolide acetate. Fertil Steril 1995 63(3): 663-5. [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 2000 15(11):2333-40. [9] Tesarik J Hasnt A Menorah C. Luteinizing hormone affects uterine receptivity independently of ovarian function. Report Become Online 2003 7(1):59-64. [10]. IVF. 2009 25(2):133-5. [11] Bjuresten K Landgren BM Hovatta O et al. Luteal phase progesterone increases live birth rate after frozen embryo transfer. Fertil Steril 2011 95(2):534-7. [12]. FSH/ -. 2010 30(7):449-52. [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 2008 25(8): 359-64. [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 2012 28(9):674-7. [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 2006 21(10):2645-9. (2014 10 30 ) ( 52 refer to p52) 36