Characteristics of ultra-long and long protocols in fresh ET cycles and effects on pregnancy outcomes
Ultra-long protocol could mediate hypo-estrogen status by pituitary downregulation and produced positive effect on pregnancy outcomes, therefore it was widely used in adenomyosis population. Compared with ultra-long protocol, long protocol also could mediate pituitary downregulation, while the function was much weaker. Because of endogenous inhibition of GnRH-a, the development of follicles mainly depended on exogenous gonadotropin. Especially in ultra-long protocol, the gonadotropin duration and dosage significantly increased. However, prolonged gonadotropin duration and increased gonadotropin dosage could recover the deeper ovarian inhibition to some extent. We found number of retrieved oocytes and 2PN zygotes had no statistical difference between ultra-long and long protocols. In our study, ultra-long protocol had severer adenomyosis, while, after long acting GnRHa pretreatment, IR, CPR, MR and LBR in ultra-long and long protocols were similar. Hou X’ study analyzed 362 ultra-long protocol cycles and 127 long protocol cycles in fresh ET cycles among adenomyosis patients, and gonadotropin dosage and duration in ultra-long protocol also significantly increased. CPR and LBR in ultra-long protocol were better than corresponding rates in long protocol (7). Lan J compared the effect of ultra-long and long protocol in women with adenomyosis (237 cycles versus 134 cycles) and similar results were supported, that was, compared with long protocol, ultra-long protocol improved pregnancy outcomes in women with adenomyosis, especially in women with diffuse adenomyosis (9). All in all, ultra-long protocol had its advantages on improvement of pregnancy outcomes for severer adenomyosis, although time and economic cost increased.