Li Fei, Zhang HuiXia, Shi WeiYi, Wu YiFang, Tian Ye, Guo YiHong, Jin HaiXia, Li Gang
Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Center for Reproductive Medicine, The First People's Hospital of Shangqiu, Shangqiu, China.
Front Physiol. 2021 Sep 27;12:732709. doi: 10.3389/fphys.2021.732709. eCollection 2021.
To explore the appropriate controlled ovarian hyperstimulation (COH) protocols in infertility patients who received the fertilization (IVF)/intracytoplasmic sperm injection (ICSI) treatments during the COVID-19 pandemic. This retrospective cohort study evaluated the efficiency of the early follicular-phase long-acting GnRH-agonist long (EFLL) protocol (a new protocol developed by Chinese clinicians), prolonged pituitary down-regulation of EFLL protocol (Pro-EFLL), and the GnRH-ant protocol for couples meeting the study criteria between February 2020 and June 2020 who were treated by the First Affiliated Hospital of Zhengzhou University during the COVID-19 pandemic, and compared the pregnancy rates and miscarriage rates per fresh transfer cycle, number of retrieved oocytes, endometrial thickness on the day of hCG injection and the number of fertilized oocytes, mature oocytes, fertilized oocytes, and transferable embryos among the three protocols. We found that the prolonged pituitary down-regulation during the COVID-19 pandemic by utilizing a full-dose of GnRH-a administrated in infertility patients were no differences in clinical outcomes than other protocols, The prolonged pituitary down-regulation protocol and EFLL protocol were associated with a higher Endometrial thickness on the day of hCG injection (12.67 ± 2.21 vs. 12.09 ± 2.35 vs. 10.79 ± 2.38, < 0.001), retrieved oocytes (14.49 ± 6.30 vs. 15.02 ± 7.93 vs. 10.06 ± 7.63, < 0.001), mature oocytes (11.60 ± 5.71 vs. 11.96 ± 6.00 vs. 7.63 ± 6.50, < 0.001), fertilized oocytes (9.14 ± 5.43 vs. 8.44 ± 5.34 vs. 5.42 ± 5.20, < 0.001), and transferable embryos (4.87 ± 2.96 vs. 6.47 ± 5.12 vs. 3.00 ± 3.28 vs. < 0.001) in the GnRH-antagonist protocol. We recommend that patients start Gn injections 33-42 days after a pituitary downregulated full dose (3.75 mg) of gonadotropin-releasing hormone agonist during the COVID-19 pandemic, even a delay of 2-4 weeks does not affect the implantation rate. The study can provide a more detailed estimate and clinical management strategies for infertile couples during the COVID-19 pandemic.
为探索在2019年冠状病毒病（COVID-19）大流行期间接受体外受精（IVF）/卵胞浆内单精子注射（ICSI）治疗的不孕症患者中合适的控制性卵巢刺激（COH）方案。这项回顾性队列研究评估了2020年2月至2020年6月期间符合研究标准、在COVID-19大流行期间于郑州大学第一附属医院接受治疗的夫妇的卵泡早期长效促性腺激素释放激素激动剂长方案（EFLL，中国临床医生制定的新方案）、EFLL方案的垂体延长降调节方案（Pro-EFLL）和GnRH拮抗剂方案的有效性，并比较了三种方案每个新鲜移植周期的妊娠率和流产率、获卵数、注射人绒毛膜促性腺激素（hCG）当天的子宫内膜厚度以及受精卯、成熟卵、受精卵和可移植胚胎的数量。我们发现，在COVID-19大流行期间，对不孕症患者使用全剂量GnRH-a进行垂体延长降调节，其临床结局与其他方案相比无差异，GnRH拮抗剂方案中的垂体延长降调节方案和EFLL方案与注射hCG当天更高的子宫内膜厚度（12.67±2.21 vs. 12.09±2.35 vs. 10.79±2.38，P<0.001）、获卵数（14.49±6.30 vs. 15.02±7.93 vs. 10.06±7.63，P<0.001）、成熟卵（11.60±5.71 vs. 11.96±6.00 vs. 7.63±6.50，P<0.001）、受精卵（丸14±5.43 vs. 8.44±5.34 vs. 5.42±5.20，P<0.001）和可移植胚胎（4.87±2.96 vs. 6.47±5.12 vs. 3.00±3.28，P < O.001）相关。我们建议，在COVID-19大流行期间，患者在垂体通过全剂量（3.75mg）促性腺激素释放激素激动剂降调节33 - 42天后开始注射促性腺激素（Gn），即使延迟2 - 4周也不影响着床率。该研究可为COVID-19大流行期间的不孕夫妇提供更详细的评估和临床管理策略。
