高孕激素下促排卵方案在卵巢正常反应人群中的应用效果评价

Evaluation of efficacy of progestin-primed ovarian stimulation protocol in IVF patients with normal ovarian response

目的比较高孕激素下促排卵方案(PPOS)与黄体期短效长方案在卵巢正常反应人群中的应用效果。方法回顾性分析2019年1月至2020年12月在武汉大学人民医院接受IVF助孕治疗且卵巢正常反应患者的临床资料,根据所使用的促排方案不同分为PPOS组(128个周期)和黄体期短效长方案组(长方案组,377个周期),比较两组患者的基本资料、促排卵用药情况及实验室结局。结果PPOS组与长方案组患者的基本资料及实验室结局(受精率、优胚率及囊胚形成率)比较均无显著性差异(P均>0.05)。但PPOS组HCG日E 2水平[(9153.00±470.00)pmol/L vs.(12691.00±562.30)pmol/L]、≥14 mm卵泡数[(7.65±5.12)个vs.(10.82±4.35)个]及平均获卵数[(8.37±3.18)枚vs.(12.31±4.01)枚]均显著低于长方案组,Gn用药时间显著短于长方案组[(9.48±1.10)d vs.(10.82±1.90)d],OHSS发生率亦显著低于长方案组(3.13%vs.10.61%)(P均<0.01)。结论对于卵巢正常反应的患者,PPOS方案可获得与黄体期短效长方案相似的实验室结局,且用药时间短,OHSS发生率低,时间与经济成本亦较低,可作为有全胚冷冻需求或常规促排卵结局不理想患者的促排卵备选方案。

Objective:To compare the efficacy of progestin-primed ovarian stimulation(PPOS)protocol with short-acting GnRH-a long protocol in luteal phase in normal ovarian responders.Methods:A retrospective study was carried out among patients who received IVF treatment in Renmin Hospital of Wuhan University from January 2019 to December 2020.They were divided into PPOS group(128 cycles)and short-acting long protocol group(long protocol group,377 cycles)according to the different induced ovulation protocol used.The baseline information,induced ovulation status and laboratory outcomes were compared.Results:There were no significant differences in baseline characteristics and laboratory indicators(fertilization rate,good-quality embryo rate,blastocyst formation rate)between two groups(P>0.05).However,the serum level of E 2 on HCG day in PPOS group was significantly lower than that in long protocol group[(9153.00±470.00)pmol/L vs.(12691.00±562.30)pmol/L](P<0.01).The number of follicles with diameter≥14 mm[(7.65±5.12)vs.(10.82±4.35)]and average number of oocytes retrieved[(8.37±3.18)vs.(12.31±4.01)]were also significantly lower in PPOS group(P<0.01).The Gn stimulation duration in PPOS group was shorter than that in long protocol group[(9.48±1.10)days vs.(10.82±1.90)days]and the OHSS rate is lower than that in long protocol(3.13%vs.10.61%)(P<0.01).Conclusions:For patients with normal ovarian response,PPOS protocol can obtain similar laboratory outcomes as the short-acting GnRH-a long protocol in luteal phase,the medication time is short,the incidence of OHSS is low,and the time and economic cost are low,which may be considered as candidates for ovarian stimulation in normal responders.