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.