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Optimizing FSH Concentration Modulation in the Short-Acting GnRH-a Long Protocol for IVF/ICSI: A Retrospective Study

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Abstract

Introduction

Exogenous gonadotropin (Gn) is given to regulate follicle-stimulating hormone (FSH) levels to achieve optimal ovarian response in in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI). The objective of this study was to analyze the optimal degree of change in FSH blood concentration with ovarian responsiveness in a short-acting gonadotropin-releasing hormone agonist (GnRH-a) long protocol for IVF/ICSI.

Methods

This retrospective study was conducted at Changzhou Maternity and Child Health Hospital's Reproductive Center from May 2017 to May 2023. A total of 794 ovarian stimulation cycles for IVF/ICSI using the short-acting GnRH-a long protocol was included. Ovarian responsiveness was assessed based on the number of follicles > 14 mm on human chorionic gonadotropin (HCG) trigger day, refine-follicular output rate (Refine-FORT) and good quality embryos. Delta 1 referred to the change in FSH level between days 6–8 of gonadotropin usage and baseline FSH, while Delta 2 referred to the change in FSH level between HCG trigger day and days 6–8 of gonadotropin usage. Simple and multiple linear regression analysis were performed to adjust for confounding factors.

Results

The number of follicles > 14 mm on HCG trigger day was found to be the most suitable indicator for evaluating ovarian responsiveness compared to the number of follicles > 16 mm and the number of retrieved oocytes. When Delta 1 ranged from 1.94 to 3.37, the number of follicles > 14 mm on HCG trigger day was the highest. When Delta 1 ranged from 3.37 to 5.90, the Refine-FORT was the highest. However, when Delta 1 exceeded 5.90, the number of follicles > 14 mm on HCG trigger day, Refine-FORT and good quality embryo all significantly decreased. On the other hand, when Delta 2 was ≤ − 1.58, the number of follicles > 14 mm on HCG trigger day and the Refine-FORT were both the highest.

Conclusion

This study identifies optimal Delta 1 and Delta 2 ranges for effective ovarian responsiveness in a short-acting GnRH-a long protocol for IVF/ICSI and introduces the novel measure of the number of follicles > 14 mm on HCG trigger day. The optimal range for Delta 1 was 1.94 to 3.37, and Delta 2 should be < − 1.58 for achieving a higher number and quality of oocytes.

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Data Availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request. Renjie Lu, Email: renjie_lu@126.com.

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Thanking Patient Participants

We thank the participants of the study.

Funding

Funding for the Rapid Service Fee was provided by Changzhou Maternity and Child Health Care Hospital (Changzhou, Jiangsu, China). This work was supported by National Key R&D Program “Fertility Health and Health Security for Women and Children”: Clinical Cohort and Intervention Study on Genetic Problems in Assisted Reproduction Offspring (2021YFC2700602); Hospital management innovation research project of Jiangsu Hospital Association in 2023 (JSYGY-3-2023-247); the special project of soft science research of Changzhou science and technology association in 2020; Jiangsu maternal and child health research project (F202052); and the open project of biological resources sample bank of major diseases in Jiangsu province in 2020 (SBK202007002); and Top Talent of Changzhou “The 14th Five-Year Plan” High-Level Health Talents Training Project (2022CZBJ084).

Author information

Author notes

  1. Lingmin Hu and Lijing Bai contributed equally to this work.

Authors and Affiliations

  1. Department of Reproduction, Changzhou Maternity and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, 213000, Jiangsu, China

    Lingmin Hu, Lijing Bai, Xiaoyu Wang, Jing Zhou, Chunmei Yu, Yang Chen, Shuxian Wang & Li Chen

  2. Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, Jiangsu, China

    Rui Qin

  3. Scientific Research and Education Department, Changzhou Maternity and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, 213000, Jiangsu, China

    Rui Qin

  4. Department of Neurology, Changzhou Third People’s Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, 213000, Jiangsu, China

    Shenyu Zhao

  5. Changzhou Third People’s Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, 213000, Jiangsu, China

    Renjie Lu

Authors
  1. Lingmin Hu
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Contributions

Lingmin Hu and Lijing Bai were responsible for the conception and design of the study as well as the acquisition of data and drafting the article. Rui Qin and Xiaoyu Wang were responsible for the interpretation of data. Jing Zhou was involved in revising the article critically for important intellectual content. Chunmei Yu and Yang Chen were responsible for giving final approval of the version to be submitted. Shuxian Wang and Shenyu Zhao took responsibility for ensuring accountability for all aspects of the work, including agreement to be accountable for questions related to accuracy and integrity of any part of the work, ensuring that any related concerns were appropriately investigated and resolved. Li Chen and Renjie Lu were responsible for maintaining the integrity of the work.

Corresponding authors

Correspondence to Li Chen or Renjie Lu.

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Conflict of Interest

Lingmin Hu, Lijing Bai, Rui Qin, Xiaoyu Wang, Jing Zhou, Chunmei Yu, Yang Chen, Shuxian Wang, Shenyu Zhao, Li Chen and Renjie Lu have nothing to disclose.

Ethical Approval

This study was conducted in accordance with the principles outlined in the Helsinki Declaration of 1964 and its later amendments. Ethical approval for this study was obtained from the Institutional Review Board of Changzhou Maternity and Child Health Hospital. All participants provided informed consent to participate in this study.

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Hu, L., Bai, L., Qin, R. et al. Optimizing FSH Concentration Modulation in the Short-Acting GnRH-a Long Protocol for IVF/ICSI: A Retrospective Study. Adv Ther 41, 215–230 (2024). https://doi.org/10.1007/s12325-023-02702-y

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