Ubaldi Filippo Maria, Capalbo Antonio, Vaiarelli Alberto, Cimadomo Danilo, Colamaria Silvia, Alviggi Carlo, Trabucco Elisabetta, Venturella Roberta, Vajta Gábor, Rienzi Laura
Valle Giulia Clinic, GENERA Centers for Reproductive Medicine, Rome, Italy; Ruesch Clinic, GENERA Centers for Reproductive Medicine, Naples, Italy; Genetyx SRL Laboratories, Marostica, Vicenza, Italy.
Valle Giulia Clinic, GENERA Centers for Reproductive Medicine, Rome, Italy; Ruesch Clinic, GENERA Centers for Reproductive Medicine, Naples, Italy; Genetyx SRL Laboratories, Marostica, Vicenza, Italy.
Fertil Steril. 2016 Jun;105(6):1488-1495.e1. doi: 10.1016/j.fertnstert.2016.03.002. Epub 2016 Mar 25.
To compare the euploid blastocyst formation rates obtained after follicular phase (FP) versus luteal phase (LP) stimulation performed in the same menstrual cycle in a preimplantation genetic diagnosis for aneuploidy testing (PGD-A) program in patients with reduced ovarian reserve.
Prospective paired noninferiority observational study.
Private infertility program.
PATIENT(S): Forty-three reduced ovarian reserve patients undergoing a PGD-A.
INTERVENTION(S): Both FP and LP stimulations using follicle-stimulating hormone and luteinizing hormone in combination with gonadotropin-releasing hormone (GnRH) antagonist starting on day 2 of the cycle and 5 days after the first oocyte retrieval, respectively, where GnRH agonist was used for both FP and LP ovulation triggering; a trophectoderm biopsy quantitative polymerase chain reaction-based PGD-A strategy; and single euploid blastocyst transfers during a subsequent natural cycle.
euploid blastocyst rate per injected metaphase 2 (MII) oocyte; secondary outcome measures: number of cumulus-oocyte complexes (COCs), MII oocytes, and blastocysts.
RESULT(S): Patients with an antimüllerian hormone level of <1.5 ng/mL, antral follicle count of <6 follicles, and/or <5 oocytes retrieved in a previous cycle were included. No statistically significant differences were found in the number of retrieved COCs (5.1 ± 3.4 vs. 5.7 ± 3.3), MII oocytes (3.4 ± 1.9 vs. 4.1 ± 2.5), or biopsied blastocysts per stimulated cycle (1.2 ± 1.2 vs. 1.4 ± 1.7) from FP versus LP stimulation, respectively. No differences were observed in the euploid blastocyst rate calculated either per biopsied blastocyst (46.9% vs. 44.8%) or injected MII oocyte (16.2% vs. 15.0%).
CONCLUSION(S): Stimulation with an identical protocol in the FP and LP of the same menstrual cycle resulted in a similar number of blastocysts in patients with reduced ovarian response. The LP stimulation statistically significantly contributed to the final transferable blastocyst yield, thus increasing the number of patients undergoing transfer per menstrual cycle.
在卵巢储备功能减退患者的植入前非整倍体检测（PGD-A）项目中，比较在同一月经周期的卵泡期（FP）与黄体期（LP）刺激后获得的整倍体囊胚形成率。
前瞻性配对非劣效性观察性研究。
私立不孕不育项目。
43例接受PGD-A的卵巢储备功能减退患者。
分别在月经周期第2天和首次取卵后5天开始，使用促卵泡激素和促黄体生成素联合促性腺激素释放激素（GnRH）拮抗剂进行FP和LP刺激，其中FP和LP排卵触发均使用GnRH激动剂；采用基于滋养外胚层活检定量聚合酶链反应的PGD-A策略；在随后的自然周期中进行单个整倍体囊胚移植。
每个注射的中期2（MII）卵母细胞的整倍体囊胚率；次要观察指标：卵丘-卵母细胞复合体（COC）、MII卵母细胞和囊胚的数量。
纳入抗苗勒管激素水平<1.5 ng/mL、窦卵泡计数<6个卵泡和/或在前一周期中回收的卵母细胞<5个的患者。分别来自FP和LP刺激的每个刺激周期中回收的COC数量（5.1±3.4对5.7±3.3）、MII卵母细胞数量（3.4±1.9对4.1±2.5）或活检囊胚数量（1.2±1.2对1.4±1.7），均未发现统计学上的显著差异。无论是按活检囊胚计算（46.9%对44.8%）还是按注射的MII卵母细胞计算（16.2%对15.0%），整倍体囊胚率均未观察到差异。
在同一月经周期的FP和LP中采用相同方案进行刺激，在卵巢反应减退的患者中产生的囊胚数量相似。LP刺激在统计学上对最终可移植囊胚产量有显著贡献，从而增加了每个月经周期接受移植的患者数量。
