AUTHOR=Zhu Xiuxian , Fu Yonglun 

TITLE=Evaluation of Ovarian Stimulation Initiated From the Late Follicular Phase Using Human Menopausal Gonadotropin Alone in Normal-Ovulatory Women for Treatment of Infertility: A Retrospective Cohort Study

JOURNAL=Frontiers in Endocrinology

VOLUME=10

YEAR=2019

URL=https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2019.00448

DOI=10.3389/fendo.2019.00448

ISSN=1664-2392

ABSTRACT=<p><bold>Objective:</bold> To investigate the feasibility of ovarian stimulation initiated in the late follicular phase using human menopausal gonadotropin (hMG) alone in ovulatory patients undergoing <italic>in vitro</italic> fertilization (IVF)/intracytoplasmic sperm injection (ICSI) treatments by comparison with that of the short gonadotropin-releasing hormone agonist (GnRH-a) protocol in terms of ovarian response, embryological characteristics, and pregnancy outcomes following frozen-thawed embryo transfer (FET) cycles.</p><p><bold>Design:</bold> Retrospective cohort study.</p><p><bold>Setting:</bold> A university-affiliated tertiary hospital.</p><p><bold>Patients:</bold> 135 infertile women undergoing their first IVF/ICSI treatment with the freeze-all strategy.</p><p><bold>Interventions:</bold> In the study group, ovarian stimulation was initiated in the late follicular phase using hMG alone, with the confirmation of dominant follicular diameter ≥ 14 mm, while a short GnRH-a protocol was adopted in the control group. Oocyte maturation was induced by human chorionic gonadotropin in both groups. All good quality embryos were cryopreserved for later transfer.</p><p><bold>Main Outcome Measures:</bold> The primary outcome was the incidence of premature luteinizing hormone (LH) surge. Secondary outcomes were the number of mature oocytes retrieved, good-quality embryo rate per oocyte retrieved, and clinical pregnancy rate following FET cycles.</p><p><bold>Results:</bold> No premature LH surge was detected during ovarian stimulation in the study group. There was no statistically significant difference in the number of mature oocytes between the two groups (10 ± 5.6 in the study group vs. 8.51 ± 5.03 in the control group, <italic>P</italic> = 0.11). Good-quality embryo rate per oocyte retrieved did not differ between the two groups: 40.18% (313/779) vs. 36.67% (253/690), <italic>P</italic> = 0.167. Clinical pregnancy rate per transfer following FET was comparable between the two groups (61.33 vs. 52.5%, <italic>P</italic> = 0.267).</p><p><bold>Conclusions:</bold> Our study shows that ovarian stimulation initiated in the late follicular phase using hMG alone may be a feasible alternative for normal-ovulatory women undergoing IVF/ICSI treatment with the freeze-all strategy.</p>