Reproductive Medicine Center, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China (mainland).
Reproductive Medicine Center, First Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (mainland).
Med Sci Monit. 2021 Apr 5;27:e929854. doi: 10.12659/MSM.929854.
BACKGROUND In controlled ovarian hyperstimulation protocols worldwide, depot gonadotropin-releasing hormone agonist (GnRH-a) pretreatment is generally used for pituitary desensitization. The delay between the GnRH-a administration and starting gonadotropin treatment varies greatly, from 25 to 60 days. However, the association between exposure days to GnRH-a before the onset of gonadotropin administration and the clinical outcomes remains unknown. MATERIAL AND METHODS This retrospective study included 7007 patients who underwent fresh embryo transfers between February 2016 and July 2019. The duration of pituitary downregulation was categorized into 3 groups: group 1, ≤30 days; group 2, 31-35 days; and group 3, ≥36 days. The rates of live birth were compared as the main outcome measure. Logistic regression analysis was also performed after controlling for a range of confounders. RESULTS The number of patients in groups 1, 2, and 3 was 2001, 2824, and 2182, respectively. Group 3 (≥36 days) had a noticeably higher live birth rate (48.1%) than the other 2 groups (42.6% and 43.9%, P=0.001). The rate of live birth was remarkably enhanced in group 3 (adjusted odds ratio: 1.264, 95% confidence interval: 1.098, 1.455, P=0.001) after controlling for confounders, while the difference was not found in group 2 (P=0.512) compared with group 1. CONCLUSIONS In the depot GnRH-a protocol, live birth rates are higher among patients needing a longer time to achieve the goal of pituitary downregulation.
在全球范围内的控制性卵巢超刺激方案中，通常使用长效促性腺激素释放激素激动剂（GnRH-a）预处理进行垂体脱敏。从 GnRH-a 给药到开始使用促性腺激素治疗之间的时间间隔差异很大，从 25 天到 60 天不等。然而，在开始使用促性腺激素之前接触 GnRH-a 的天数与临床结局之间的关联尚不清楚。
这项回顾性研究纳入了 2016 年 2 月至 2019 年 7 月期间进行新鲜胚胎移植的 7007 名患者。垂体下调的持续时间分为 3 组：组 1，≤30 天；组 2，31-35 天；组 3，≥36 天。主要观察指标为活产率。还进行了逻辑回归分析，以控制一系列混杂因素。
组 1、组 2 和组 3 的患者人数分别为 2001、2824 和 2182 名。组 3（≥36 天）的活产率（48.1%）明显高于其他 2 组（42.6%和 43.9%，P=0.001）。在控制混杂因素后，组 3（调整后的优势比：1.264，95%置信区间：1.098，1.455，P=0.001）的活产率显著提高，而组 2 与组 1 相比差异无统计学意义（P=0.512）。
在 GnRH-a 长效方案中，需要更长时间才能达到垂体脱敏目标的患者的活产率更高。
