分析高孕酮状态下促排卵方案温和刺激和常规刺激对波塞冬第4组人群累积活产率的影响

Analysis of the cumulative live birth rate of Poseidon 4 group by mild stimulation and conventional stimulation with progestin-primed ovarian stimulation protocols

目的评估高孕酮状态下促排卵方案(progestin-primed ovarian stimulation protocols,PPOS)中,温和刺激和常规刺激在波塞冬4组人群中的累积活产率(cumulative live birth rate,CLBR)。方法本研究属于单中心、回顾性队列研究。研究纳入2017年1月至2020年3月期间在郑州大学第三附属医院生殖中心首次行体外受精/卵胞质内单精子注射(in vitro fertilization/intracytoplasmic sperm injection,IVF/ICSI)助孕的周期,纳入符合波塞冬标准第4组患者,所有患者均行PPOS。根据促性腺激素(gonadotropin,Gn)启动剂量不同,分为温和刺激和常规刺激两组。温和刺激组Gn启动剂量为150 U;常规刺激组Gn启动剂量为300 U。主要观察指标为CLBR。次要观察指标为获卵数、双原核(two pronuclei,2PN)数、可利用胚胎数、优质胚胎数和累积妊娠率。结果共有1334个周期符合纳入排除标准,经倾向性评分匹配(propensity score matching,PSM)模型1∶3匹配后,共纳入温和刺激116个周期,常规刺激348个周期进行统计描述和分析。常规刺激组的Gn用量[2700.00(2400.00,3300.00)U]显著高于温和刺激组[1500.00(918.75,2456.25)U,P<0.001]。常规刺激组的获卵数[3.00(2.00,4.00)个]、2PN数[2.00(1.00,3.00个)]、可利用胚胎数[1.00(1.00,2.00)个]和优质胚胎数[1.00(0.00,1.00)个]显著高于温和刺激组[2.00(1.00,3.00)个,P<0.001;1.00(1.00,2.00)个,P=0.002;1.00(0.00,2.00)个,P=0.002;0.00(0.00,1.00)个,P=0.025]。温和刺激和常规刺激的累积妊娠率差异无统计学意义[分别为15.52%(18/116),19.54%(68/348),P=0.334]。温和刺激组的CLBR为11.21%(13/116),常规刺激组的CLBR为14.08%(49/348),两组间差异无统计学意义(P=0.431)。结论常规卵巢刺激的Gn用量增加,获卵数和可利用胚胎数多于温和刺激,但两种刺激方案的CLBR是相似的。因此,对于使用PPOS方案的卵巢低预后患者,温和刺激也是一种重要的临床选择。

ObjectiveTo evaluate the cumulative live birth rate(CLBR)of mild stimulation and conventional stimulation in Poseidon 4 group for progestin-primed ovarian stimulation protocols(PPOS).MethodsIt was a single-center,retrospective cohort study.The study included the first in vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI)cycles in the Reproductive Center of the Third Affiliated Hospital of Zhengzhou University from January 2017 to March 2020,and included patients met the criteria of Poseidon 4 group and accepted PPOS.According to the different starting dosage of gonadotropin(Gn),it was divided into mild stimulation group and conventional stimulation group.In mild stimulation group,Gn starting dosage was 150 U,and in conventional stimulation group Gn starting dosage was 300 U.The primary outcome measure was CLBR.Secondary observation indicators were No.of oocytes retrieved,No.of two pronuclei(2PN),No.of available embryos,No.of high-quality embryos and cumulative pregnancy rate.ResultsA total of 1334 cycles met the inclusion and exclusion criteria.After 1∶3 propensity score matching(PSM)model,116 cycles of mild stimulation and 348 cycles of conventional stimulation were included for analysis.The total dosage of Gn used in the conventional ovarian stimulation group was significantly higher than that in the mild stimulation group[2700.00(2400.00,3300.00)U vs.1500.00(918.75,2456.25)U,P<0.001].The number of oocytes retrieved[3.00(2.00,4.00)],2PN[2.00(1.00,3.00)],available embryos[1.00(1.00,2.00)]and high-quality embryos[1.00(0.00,1.00)]in the conventional stimulation group were significantly higher than those in the mild stimulation group[2.00(1.00,3.00),P<0.001;1.00(1.00,2.00),P=0.002;1.00(0.00,2.00),P=0.002;0.00(0.00,1.00),P=0.025].There was no statistical difference in the cumulative pregnancy rate between mild stimulation and conventional stimulation[15.52%(18/116)vs.19.54%(68/348),P=0.334].The CLBR of the mild stimulation group was 11.21%(13/116),and the CLBR of the conventional stimulation group was 14.08%(49/348),with no significant difference between the two groups(P=0.431).ConclusionConventional stimulation increased the dosage of Gn used,and the number of oocytes retrieved and available embryos were more than those in mild stimulation,but the CLBR was similar between the two protocols.Therefore,mild stimulation is also an important clinical option for patients with low ovarian prognosis.