ObjectiveTo compare the clinical outcomes of different pituitary down regulation protocols with gonadotropin-releasing hormone agonist (GnRH-a) in patients undergoing in vitro fertilization and embryo transfer (IVF-ET) treatment. MethodsThe clinical data of 358 IVF cycles in women at 40 years old or younger from November 2012 to January 2013 in the West China Second University Hospital were analyzed retrospectively. All the 358 cycles were divided into two groups, according to whether the leading follicle diameter was <14 mm (group A, 158 cycles) or ≥14 mm (group B, 200 cycles) after discontinuing the GnRH-a. The clinical outcomes were compared between the two groups. ResultsCompared with group B, the amount of gonadotropins used was significantly more, and the time of gonadotropin use was also significantly longer in group A (P<0.05). However, the serum level of estradiol (E2), progesterone (P) and Luteinizing hormone (LH), incidence of premature P rise, retrieved ovum number, the rates of implantation, clinical pregnancy, miscarriage and live birth did not significantly differ between the two groups (P>0.05). ConclusionDiscontinuing the use of GnRH-a in early stage of controlled ovarian stimulation can keep effective pituitary down regulation and it has the same optimal clinical outcomes in patients undergoing IVF-ET.
ObjectiveTo investigate the effect of laparoscopic surgery combined with the following treatment of gonadotropin-releasing hormone agonist (GnRH-a) on the patients with endometriotic infertility and the value of endometriosis fertility index (EFI) system on forecasting the pregnancy outcome. MethodsFrom January 2005 to July 2011, the clinical data of 15 patients with endometriotic infertility patients were analyzed retrospectively. All the patients underwent laparoscopic surgery, and the effect was evaluated according to the endometriosis fertility index (EFI). Then all the patients were divided randomly into two groups on the basis of the different assisted treatment after the laparoscopic surgery:the control group (without any other therapy) and the GnRh-a group (combined with GnRH-a). Eventually, the pregnant rates were calculated respectively in the different groups or according to the different EFI. ResultsAt last, 103 cases finished the follow-up. The pregnancy rate in the control group after 6 months, 1 year and 3 years therapy were 12.5%, 31.2%, and 41.7%, respectively; while in the GnRh-a group were 0%, 16.3%, and 40.0%, respectively. There were no difference between the two groups after the 1 year and 3 years therapy (P>0.05). Besides, all of the 55 cases in the GnRh-a group had side-effects, but no severe adverse effect was encountered. All the side-effects were disappeared after stopping the treatment. The pregnancy rate of the patients with the EFI score of 8-10 was respectively 31.3% 1 year and 62.5% 3 years after the treatment. However, the pregnancy rate of the patients with the EFI score of 5-7 was respectively 15.2% 1 year and 26.0% 3 years after the treatment. There were only 9 patients with the EFI score of 0-4, and all of them were not pregnant. The EFI score had positive correlation with the pregnancy rate 1 year and 3 years after the treatment (rs=0.204, P=0.039; rs=0.437, P<0.001). ConclusionThe treatment of GnRh-a after the laparoscopic surgery can not only increase the rate of the pregnancy, but also delay the pregnancy occasion and increase the occurrence of the side-effects. The EFI may be valuable for forecasting the rate of pregnancy in patients with endometriotic infertility. The patients with EFI score higher than 8 may expect the pregnancy, while the ones with below 7 probably have much lower rate of natural pregnancy rate.
ObjectivesTo evaluate and compare the clinical impact of different methods of trigger in polycystic ovary syndrome (PCOS) with high ovarian response undergoing in vitro fertilization-embryo transfer (IVF-ET) cycles.MethodsA total of 323 PCOS patients with high ovarian response in an gonadotrophin-releasing hormone antagonist protocol in our reproductive medical center from January 1st, 2017 to December 31st, 2017 were included. Then they were divided into two groups based on the different trigger modes: Group A: gonadotrophin-releasing hormone agonist (GnRH-a) with low dose human chorionic gonadotrophin (HCG); Group B: HCG as trigger. Analysis and comparison of the general data of the two groups of patients, ovulation induction cycle treatment, embryo laboratory indicators and resuscitation cycle treatment outcome were performed retrospectively.ResultsThere were no significant differences in baseline such as ages, BMI, startup dose of Gn, the total dosage of drugs, promote ovulation days and so on (P>0.05). The serum E2 level on trigger day in group A was significantly higher than those in group B (7 256.94±2 031.92 vs. 6 200.26±1 001.44, P<0.05). There were no significant differences in the retrieved oocytes (23.90±7.99 vs. 23.81±7.15), binuclear fertilization rate (58.19% vs. 56.30%), and the number of frozen embryos (12.81±5.45 vs. 11.07±5.36) between two groups (P>0.05). There were also no significant differences between two groups in the incidence of moderate to severe OHSS (5.98% vs. 7.87%), clinical pregnancy rate (59.28% vs. 57.53%), implantation rate (41.05% vs. 38.24%), miscarriage rate (9.28% vs. 8.22%) and live birth rate (47.42% vs. 41.10%) during the frozen-thawed cycles (P>0.05).ConclusionsFor high responders of PCOS patients with GnRH antagonist protocol, using GnRH-a with low dose HCG as trigger maybe could decrease the incidence of moderate to severe OHSS. Embryo resuscitation and transfer cycle can also obtain ideal outcome.
Objective To systematically review the efficacy and safety of 3-month sustained releasing gonadotropin-releasing hormone agonist (GnRHa) (GnRHa 3M) and 1-month sustained releasing GnRHa (GnRHa 1M) in the treatment of pre-menopausal females with hormone receptor-positive breast cancer. Methods Databases including CNKI, WanFang Data, PubMed, EMbase and Web of Science were electronically searched to collect randomized controlled trials(RCTs) of GnRHa in the treatment of hormone receptor-positive breast cancer from inception to May 18th, 2021. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of the included studies. The gemtc software package in R 3.6.1 software and Stata 15.0 software were used for network meta-analysis. Results A total of 11 RCTs including 7 484 patients were included. The network meta-analysis results showed that there was no significant difference between GnRHa 3M and GnRHa 1M in E2 level (MD=−1.3, 95%CI −13 to 9.6), DFS (HR=1.2, 95%CI 0.88 to 1.7) and OS (HR=2.0, 95%CI 0.75 to 4.9). For safety, there was no significant difference between the two groups (RR=1.0, 95%CI 0.25 to 4.2). Conclusion Current evidence shows that the efficacy and safety of GnRHa 3M is similar to that of GnRHa 1M. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusions.