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Abstract
Objective: The objective of this study is to investigate whether the degree of down-regulation using GnRH-agonists is associated with pregnancy outcomes.
Study design: 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.
Conclusion: 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.
Chinese abstract
目的：研究的目的是调查研究应用促GnRHa方案降调程度是否与妊娠结局有关。研究设计：回顾性分析了2514名患者应用黄体期长方案的2708个降调周期。降调后的血清雌二醇（DLFD）和促黄体生成素（LHD）水平、最大卵泡直径（DLFD）和子宫内膜厚度（ENTD）用来评估降调程度。统计学方法应用单因素方差分析，Bonferroni校正、卡方检验和多变量逻辑回归分析。
结果：累积临床妊娠率（CCPR）和累积活产率（CLBR）在E2D<30 pg/ml (分别为63.7%, OR=1.405 (1.055–1.870) ， 56.8%, OR = 1.372 (1.039–1.813)) 和30–55pg/ml (分别为66.8%, OR= 1.439 (1.104–1.874) ，59.8%, OR= 1.397 (1.080–1.806))高于 E2D>55 pg/ml (62.8% ，54.7%).在DLFD>10mm 或 ENTD≥6mm的周期中CCPRs和CLBRs有低的低趋势，但差异并不显著。
结论：降调程度与卵巢反应、妊娠和活产相关。我们提出以下为最佳降调的标准：E2D 30-55 pg/ml, ENTD<6 mm，没有明显卵巢活动。
Acknowledgements
The authors thank the professional English editing service (http://www.aje.com/) for their language editing.
Declaration of interest
The authors report no declarations of interest.