PPOS方案用于卵巢高反应患者的效果评价

Evaluationof the effectiveness of PPOS protocol in patients with ovarian hyperresponse

目的探讨应用高孕激素下促排卵(progestin-primed ovarian stimulation,PPOS)方案与拮抗剂方案促排卵对卵巢高反应患者的胚胎质量和妊娠结局的影响。方法回顾性分析2021年1月至2022年12月在哈尔滨医科大学附属第一医院生殖医学科行体外受精(in vitro fertilization,IVF)/卵细胞浆内单精子注射(intracytoplasmic sperm injection,ICSI)的158例卵巢高反应患者的临床资料,根据促排卵方案不同分为两组,PPOS组:应用PPOS方案73例,拮抗剂组:应用拮抗剂方案85例。比较两种不同方案对于促排卵情况、胚胎情况和首次冷冻复苏移植后妊娠结局的影响。结果两组一般资料比较差异均无统计学意义(P>0.05)。促排卵情况:PPOS组成熟卵母细胞率(85.38%)、两个原核卵裂率(98.66%)明显高于拮抗剂组(82.07%、96.57%),差异有统计学意义(P<0.05)。PPOS组早发性黄体生成素(luteinizing hormone,LH)峰率明显低于拮抗剂组(1.37%vs 10.59%),差异有统计学意义(P<0.05)。术后并发症情况比较,PPOS组卵巢过度刺激综合征(ovarian hyperstimulation syndrome,OHSS)发生率明显低于拮抗剂组(0%vs 7.06%),差异有统计学意义(P<0.05)。妊娠情况比较,两组生化妊娠率、胚胎种植率、临床妊娠率、早期流产率差异无统计学意义(P>0.05)。结论对于卵巢高反应患者,应用PPOS方案促排卵能够降低早发LH峰率,OHSS发生率明显降低,获得与拮抗剂方案相同的胚胎质量和妊娠结局。

Objective To explore the effects of progestin-primed ovarian stimulation(PPOS)and antagonist ovarian stimulation on embryo quality and pregnancy outcome in patients with high ovarian response.Methods Retrospective analysis of the clinical data of 158 ovarian hyperreaction patients who underwent in vitro fertilization(IVF)/intracytoplasmic sperm injection(ICSI)at the Reproductive Medicine Department of the First Affiliated Hospital of Harbin Medical University from January 2021 to December 2022.Patients were divided into two groups according to different ovulation induction regimen,PPOS Group:73 cases using PPOS regimen,antagonist Group:85 cases using antagonist regimen.To compare the effects of two different regiments on ovulation induction,embryo condition and pregnancy outcome after first cryo-resuscitation transplantation.Results There was no significant difference in general data between the two groups(P>0.05).In ovulation induction,the rate of mature oocytes(85.38%)and cleavage rate of two pronucleus(98.66%)in PPOS Group were significantly higher than those in antagonist Group(82.07%、96.57%),with statistical significance(P<0.05).The peaks rate of luteinizing hormone(LH)in PPOS Group were significantly lower than those in antagonist Group(1.37%vs 10.59%),with statistical significance(P<0.05).After operation,the incidence of ovarian hyperstimulation syndrome(OHSS)in PPOS Group was significantly lower than that in antagonist Group(0%vs 7.06%),with statistical significance(P<0.05).There were no significant differences in the biochemical pregnancy rate,embryo implantation rate,clinical pregnancy rate and early abortion rate between the two groups(P>0.05).Conclusion For patients with ovarian hyperresponse,the application of PPOS regimen to promote ovulation can reduce the early LH peak rate,significantly reduce the incidence of OHSS,and obtain the same embryo quality and pregnancy outcome as the antagonist regimen.