Application of antagonist regimen in patients with failed pregnancy assisted by previous long-term regimen during early follicular phase.

Objective: To investigate the clinical application of gonadotropin-releasing hormone antagonist (GnRH-ant) in patients with failed pregnancy assisted by the previous long-term regimen during early follicular phase (EFP).

Methods: A total of 122 patients with good ovarian function and two previous failed EFP long-term assisted pregnancy were selected from the reproductive center of our hospital for study. All patients were assisted by in vitro fertilization-embryo transfer (IVF-ET) twice. According to the random number table method, the participants were divided into group A (n=61) for subcutaneous injection of gonadotropin-releasing hormone agonist (GnRH-a) and group B (n=61) for GnRH-ant, and the clinical efficacy of the two groups were observed.

Results: Group B presented reduced dosage and duration of Gn, increased number and probability of eggs retrieved, and increased number of 2PN, cleavage and transplantable embryos than group A (all P<0.05). Serum estradiol (E2) and luteinizing hormone (LH) levels elevated and T level decreased in group B as compared to group A (all P<0.05). There was no significant difference in follicle-stimulating hormone (FSH) indexes between the two groups (P>0.05). Endometrial thickness and mean ovarian volume (MOV, the mean volume of bilateral ovaries) were not significantly different between group A and group B before treatment (both P>0.05), while were lower in group B than in group A after treatment (both P<0.05). Group B had higher high-quality egg rate (%), fertilization rate (should have numbers here %), cleavage rate (%), high-quality embryo rate (should have numbers here %) and cumulative pregnancy rate (%) than group A (all P<0.05). The incidences of moderate OHSS, early abortion and hydrosalpinx were lower in group B than in group A (all P<0.05), while there was no evident difference between the two groups in the occurrence of severe OHSS and ectopic pregnancy (both P>0.05).

Conclusion: GnRH-ant can improve the clinical high-quality embryo rate in patients with the previous failed EFP long-term assisted pregnancy, and reduce the occurrence of OHSS events. Compared with GnRH-a, GnRH-ant is more suitable for clinical application of controlled ovarian hyperstimulation.