Impact of the duration of gonadotropin stimulation in women with polycystic ovary syndrom that using long-acting gonadotropin-releasing hormone agonist long protocol in follicular phase

Abstract

Objective To retrospectively analyze the clinical outcomes of patients with different duration of gonadotropin (Gn) stimulation during in vitro fertilization/intracytoplasmic sperm injection-embry transfer (IVF/ICSI-ET) and the related factors that prolong the duration of gonadotropin stimulation in patients with polycystic ovary syndrome (PCOS). Methods Clinical data of PCOS patients treated by long-acting gonadotropin-releasing hormone agonist (GnRH-a) long protocol in follicular phase were collected from January 2014 to May 2017. According to the duration of Gn stimulation with the quartile method, patients were divided into three groups (group A: 75%, the duration of Gn used > 15 d, 216 cycles), and the basic situation of patients and treatment-related indicators were compared among the groups. Results The average age, body mass index (BMI), basal follicle stimulating hormone (FSH), the level of luteinizing hormone (LH) on the start-up day, dosage of Gn used, basal testosterone (T) and the level of FSH on the start-up day were significant differences among the three groups (P<0.05). The duration of infertility, basal LH and basal estradiol (E2), the duration of down-regulation, the dosage of Gn used and the level of E2 on start-up day were not significantly different among the three groups. There was no significant difference among the three groups in the number of oocytes retrieved, the number of available embryos, cycle cancellation rate, fresh embryo transfer rate, clinical pregnancy rate, embryo implantation rate, early miscarriage rate and moderate-to-severe ovarian hyperstimulation syndrome (OHSS) incidence. The incidence of moderate and severe OHSS in group A had an increased trend compared with group B and group C. Multi-factor logistic regression analysis showed that basal FSH, basal T and BMI were the risk factors of Gn prolongation, while the start-up day FSH and start-up day LH recover were protective factors of Gn prolongation. Conclusion Prolong the duration of Gn stimulation does not affect the clinical outcome of patients with PCOS using long-acting GnRH-a long protocal in follicular phase, suggesting not canceling cycles. Weight loss before the start of treatment and supplement exogenous LH are important to avoid the duration of Gn stimulation is too long. Key words: Polycystic ovary syndrome (PCOS); Duration of gonadotropin stimulation; Gonadotropin-releasing hormone agonist (GnRH-a); Down-regulation; Clinical pregnancy rate