目的:探讨早卵泡期长效长方案（长长方案）和拮抗剂方案在预期卵巢高反应患者中的临床应用。方法:回顾性队列研究分析2015年9月至2019年5月期间在郑州大学第三附属医院生殖中心行体外受精/卵胞质内单精子注射-胚胎移植（IVF/ICSI-ET）的预期卵巢高反应患者共2575个周期的临床资料，其中长长方案组1855个周期，拮抗剂方案组720个周期，比较两组患者的临床和实验室指标、全部胚胎冷冻第一周期移植的妊娠结局、每取卵周期的累积妊娠率及首次IVF/ICSI助孕周期妊娠所需时间（TTP）；并采用自身对照研究回顾性分析其中前次行长长方案助孕再次拮抗剂方案助孕周期的临床资料及前次行长长方案助孕再次行长长方案助孕周期的临床资料。结果:①两组患者的年龄、体质量指数（BMI）、基础卵泡刺激素（bFSH）、抗苗勒管激素（AMH）、人绒毛膜促性腺激素（hCG）注射日内膜厚度差异均无统计学意义（n P>0.05）。长长方案组促性腺激素（Gn）启动量［（135.11±36.61） IU］、获卵数［（17.79±7.80）枚］、可利用胚胎数［（9.08±5.56）枚］、优质胚胎数［（5.18±4.56）枚］明显低于拮抗剂组［（170.12±53.94） IU、（20.60±9.92）枚、（10.96±6.59）枚、（6.47±4.97）枚］（n P0.05）；拮抗剂组新鲜周期移植后妊娠和冷冻胚胎周期移植后妊娠的周期TTP［（47.67±3.18）d、（140.33±45.43）d］要明显少于长长方案组［（81.25±3.72）d、（185.19±46.52）d，n P均0.05）。④长长方案和拮抗剂方案自身对照的比较显示：长长方案组可利用胚胎数［（5.79±3.14）枚］、优质胚胎数［（2.78±1.50）枚］明显低于拮抗剂组［（10.14±4.74）枚、（5.70±3.50）枚］（n P=0.027、n P=0.005），而Gn使用总量［（2 535.80±1 212.17） IU］、中重度OHSS发生率（4.55%）明显高于拮抗剂组［（2 075.28±856.03） IU、0］（n P=0.049、n P=0.043）。⑤长长方案助孕和再次长长方案自身对照的比较显示：再次长长方案助孕的BMI［（24.63±2.99） kg/mn 2］小于第一周期长长方案者［（25.01±3.12） kg/mn 2，n P=0.049］，而优质胚胎数［（4.00±3.58）枚］和临床妊娠率（52.10%）明显高于第一周期长长方案者［（2.56±2.12）枚、29.41%］（n P=0.046、n P=0.004）。n 结论:对于预期卵巢高反应的患者，拮抗剂方案可显著降低促排卵时间、促排卵剂量、中重度OHSS发生率，提高获卵数、可利用胚胎数及优质胚胎数，但新鲜周期临床妊娠率低，可考虑全部胚胎冷冻后移植。对于前次长长方案助孕失败的预期卵巢高反应患者，下一周期可考虑拮抗剂方案，亦可在改善基础状态并预防OHSS发生的基础上再次选择长长方案。“,”Objective:To investigate clinical outcomes and safety of the early follicular phase prolonged protocol and gonadotropin-releasing hormone antagonist (GnRH-A) protocol of patients with expected high ovarian response.Methods:A retrospective cohort analysis of the expected high ovarian response patients during n in vitrofertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET) was performed in the Reproductive Center of the Third Affiliated Hospital of Zhengzhou University from September 2015 to May 2019, including 1855 gonadotropin-releasing hormone agonist (GnRH-a) cycles and 720 GnRH-A cycles. The main outcome measures were the clinical outcomes, the incidence of moderate to severe ovarian hyperstimulation syndrome (OHSS), the pregnancy outcome of the first cycle of whole embryo freezing, cumulative pregnancy rate per oocytes retrieval cycle and time to pregnancy (TTP). And a self-controlled study was performed to compare the clinical outcomes of the patients who underwent early follicular phase prolonged protocol previously and underwent GnRH-A protocol or early follicular phase prolonged protocol later.n Results:1) There was no statistical difference between GnRH-a group and GnRH-A group in maternal age, body mass index (BMI), basal follicle-stimulating hormone (bFSH), anti-Müllerian hormone (AMH) and intima thickness on the human chorionic gonadotropin (hCG) trigger day (n P>0.05). Compared with the Gn start-up [(170.12±53.94) IU], No. of obtained oocytes (20.60±9.92), No. of available embryos (10.96±6.59), and No. of high-quality embryos (6.47±4.97) in the GnRH-A group, the gonadotropins (Gn) start-up [(135.11±36.61) IU], No. of obtained oocytes (17.79±7.80), No. of available embryos (9.08±5.56), and No. of high-quality embryos (5.18±4.56) in the early follicular phase prolonged protocol group were significantly reduced correspondingly (n P0.05); the TTP of GnRH-A after fresh embryo transfer [(47.67±3.18) d] and frozen embryo cycle [(140.33±45.43) d] were significantly less than those in the early follicular phase prolonged protocol group [(81.25±3.72) d, (185.19±46.52) d,n P0.05). 4) The comparison of early follicular phase prolonged protocol and GnRH-A protocol self-control showed that No. of available embryos (5.79±3.14) and No. of high-quality embryos (2.78±1.50) in early follicular phase prolonged protocol were significantly lower than those in GnRH-A group (10.14±4.74, 5.70±3.50) (n P=0.027, n P=0.005), and the total Gn used dosage [(2 535.80±1 212.17) IU] and moderate to severe OHSS incidence rate (4.55%) were significantly higher (n P=0.049, n P=0.043). 5) The comparison of early follicular phase prolonged protocol and self-control of early follicular phase prolonged protocol protocol again showed that the BMI assisted by the early follicular phase prolonged protocol again [(24.63±2.99) kg/mn 2] was lower than that of the early follicular phase prolonged protocol in the first cycle [(25.01±3.12) kg/mn 2, P=0.049], while the No. of high-quality embryos (4.00±3.58) and the clinical pregnancy rate of early follicular phase prolonged protocol again (52.10%) were significantly higher than those of the first cycle (2.56±2.12, 29.41%) (n P=0.046, n P=0.004).n Conclusion:For patients with high expected response, the GnRH-A protocol can significantly reduce the duration of Gn used, the dosage of Gn used and the incidence of moderate to severe OHSS, increase the No. of oocytes, the No. of available embryos and the No. of high-quality embryos. The clinical pregnancy rate of the fresh cycle was lower in GnRH-A protocol, and whole embryo freezing can be considered. For the previous early follicular phase prolonged protocol patients, GnRH-A protocol can be considered next time, and the early follicular phase prolonged protocol can be selected again based on improvement of the basic state and prevention of OHSS.