年轻卵巢功能减退患者使用微刺激方案和高孕激素促排卵方案IVF-ET的疗效比较

Progestin-primed ovarian stimulation versus mild stimulation protocol in young patients with diminished ovarian reserve undergoing in vitro fertilization cycle

目的:探讨高孕激素促排卵方案(PPOS)和微刺激方案在年轻卵巢储备功能减退患者(DOR)体外受精-胚胎移植(IVF-ET)结局。方法:回顾分析2019年10月至2022年10月在南京医科大学附属泰州人民医院生殖中心行IVF-ET辅助生殖技术的147例年轻DOR(年龄≤35岁)患者的资料,其中PPOS组108例,微刺激方案组39例,比较两组患者的一般资料、促排卵情况、实验室指标、周期异常情况和临床结局。结果:PPOS组的Gn用量、Gn使用时间、扳机日E 2及获卵数均高于微刺激方案组,扳机日LH、正常受精率低于微刺激方案组,差异均有统计学意义(P<0.05)。两组的周期取消率、临床结局比较,差异均无统计学意义(P>0.05)。结论:相对微刺激方案,PPOS方案能降低年轻DOR患者的早发LH峰风险、获得更多的卵子,但Gn用量大、用药时间长、正常受精率更低,没有改善临床结局。因此,相较于PPOS方案,微刺激方案更贴近自然周期且经济实惠,可作为年轻DOR患者行IVF-ET治疗时的较优选择。

Objective:To compare the clinical outcome of progestin-primed ovarian stimulation(PPOS)with mild stimulation protocol in young patients with diminished ovarian reserve(DOR)undergoing in vitro fertilization cycle(IVF-ET).Methods:The data of 147 young patients(under 35 years old)with DOR who underwent IVF-ET in the Affiliated Taizhou Peoples Hospital of Nanjing Medical University between October 2019 and October 2022 were analyzed restropectively,108 of whom received PPOS protocol while 39 patients received mild stimulation protocol.Comparisons of the basic information,ovarian stimulation status,laboratory parameters,abnormal conditions in treatment and clinical outcomes between two groups were performed by univariable analysis.Result:A greater amount of total gonadotropin,longer duration of stimulation,higher Estradiol on HCG day,higher number of retrieved oocytes and lower value of luteinizing hormone(LH)were observed in the PPOS group(P<0.05).The normal fertilization rate was higher in the mild stimulation group than that in the PPOS group(P=0.013).There were no significant differences of the abnormal conditions in the treatment and clinical outcomes between the two groups(all P>0.05).Conclusions:Although a lower risk of premature luteinizing hormone(LH)surge and a higher number of retrieved oocytes were observed in the PPOS group,either the duration of stimulation or the amount of total gonadotropin was greater in PPOS group than those in the mild stimulation protocol group.In addition,the normal fertilization rate was lower in the PPOS group.The clinical outcome of patients undergone PPOS protocol was no better than that of the mild stimulation protocol.So,as a protocol which maybe more economical and closer to the natural ovulation cycle compared with the PPOS protocol,the mild stimulation protocol may be a better choice for young patients with DOR undergoing IVF-ET.