The criteria for optimal down-regulation with gonadotropin-releasing hormone-agonist: a retrospective cohort study.
OBJECTIVE
The objective of this study is to investigate whether the degree of down-regulation using GnRH-agonists is associated with pregnancy outcomes.


METHODS
This retrospective analysis was performed on 2708 cycles from 2514 patients undergoing down-regulation with the luteal phase long protocol. The serum oestradiol (E2D) and luteinising hormone (LHD) levels, the diameter of the largest follicle (DLFD) and the endometrial-thickness (ENTD) after down-regulation were used to evaluate the degree of down-regulation. One-way analysis of variance with the Bonferroni adjustment, the chi-square test and multivariate logistic regression analyses were used for the statistical analysis.


RESULTS
The cumulative clinical pregnancy rates (CCPR) and the cumulative live birth rates (CLBR) were higher in the cycles with E2D < 30 pg/ml (63.7%, OR = 1.405 (1.055-1.870) and 56.8%, OR = 1.372 (1.039-1.813)) and 30-55pg/ml (66.8%, OR = 1.439 (1.104-1.874) and 59.8%, OR = 1.397 (1.080-1.806)) than in those with E2D > 55 pg/ml (62.8% and 54.7%). There was a trend towards lower CCPRs and CLBRs in the cycles with DLFD > 10 mm or ENTD ≥ 6 mm; however, this difference was not significant.


CONCLUSIONS
The degree of down-regulation is associated with ovarian response, pregnancy, and live birth. We propose the following criteria for optimal down-regulation: E2D 30-55 pg/ml, ENTD < 6 mm, and no apparent ovarian activity.
a Reproductive Medicine Center, Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology , Wuhan , Hubei , China.
Yu
Y
Zheng
a Reproductive Medicine Center, Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology , Wuhan , Hubei , China.
Xiyuan
X
Dong
a Reproductive Medicine Center, Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology , Wuhan , Hubei , China.
Rui
R
Wang
a Reproductive Medicine Center, Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology , Wuhan , Hubei , China.
Wei
W
Yang
a Reproductive Medicine Center, Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology , Wuhan , Hubei , China.
Hanwang
H
Zhang
a Reproductive Medicine Center, Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology , Wuhan , Hubei , China.
Guijin
G
Zhu
a Reproductive Medicine Center, Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology , Wuhan , Hubei , China.
Jihui
J
Ai
D000328:Adult; D015331:Cohort Studies; D046149:Embryo Culture Techniques; D004624:Embryo Transfer; D004717:Endometrium; D004958:Estradiol / Q000097:blood; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods*; D005640:Follicle Stimulating Hormone / Q000097:blood; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists*; D006801:Humans; D007986:Luteinizing Hormone / Q000037:antagonists & inhibitors / Q000097:blood*; D010053:Ovary / Q000502:physiology; D011247:Pregnancy; D011256:Pregnancy Outcome; D018873:Pregnancy Rate; D012189:Retrospective Studies; D020554:Sperm Injections, Intracytoplasmic; D017329:Triptorelin Pamoate / Q000008:administration & dosage
D017329:Triptorelin Pamoate; D007987:Gonadotropin-Releasing Hormone; D004958:Estradiol; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone
Clinical pregnancy; down-regulation; live birth; ovarian response