Chen Qiuju, Wang Yun, Sun Lihua, Zhang Shaozhen, Chai Weiran, Hong Qingqing, Long Hui, Wang Li, Lyu Qifeng, Kuang Yanping
Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Zhizaoju road no 639, Shanghai, People's Republic of China.
Reprod Biol Endocrinol. 2017 Sep 5;15(1):71. doi: 10.1186/s12958-017-0291-0.
The use of progestin (P) during ovarian stimulation is effective in blocking the luteinizing hormone (LH) surge in women with normal ovarian reserve, however, its effects have not been determined in poor responders. This study aimed to explore the follicular dynamics in P-primed minimal stimulation in poor responders.
A total of 204 infertile women with diminished ovarian reserve were allocated into the medroxyprogesterone acetate (MPA) group or the natural-cycle control group in an alternating order. MPA (10 mg) was administered daily beginning from the early follicular phase and a low dose of hMG was added in the late follicular phase if the serum FSH level was lower than 8.0mIU/ml. When a dominant follicle reached maturity, triptorelin 100 μg and hCG 1000 IU were used for trigger, and oocytes were retrieved 34-36 h later.All viable embryos were cryopreserved for subsequent frozen embryo transfer. Natural cycle IVF was used as controls.
Compared with the natural cycle group, the MPA group exhibited a larger pre-ovulatory follicle (18.7 ± 1.8 mm vs 17.2 ± 2.2 mm), a longer follicular phase (13.6 ± 3.6 days vs 12.3 ± 3.2 days), and higher peak oestradiol values (403.88 ± 167.16 vs 265.26 ± 122.16 pg/ml), while maintaining lower LH values (P < 0.05). The incidences of spontaneous LH surge and premature ovulation decreased significantly (1.0% vs 50%; 2% vs. 10.8%, respectively; P < 0.05). A greater number of oocytes and viable embryos were harvested from the MPA group than from the natural cycle group (P < 0.05). Moreover,the clinical pregnancy rate was slightly higher in the MPA group than in the natural cycle controls, but the difference was not significant (11.8% vs 5.9%, P > 0.05).
This study supported the hypothesis that P-primed minimal stimulation achieved ovulation control of the dominant follicle and did not adversely affect the quality of oocytes in poor responders. Therefore, P-priming is a promising approach to overcome premature ovulation in minimal stimulation for poor responders.
ChiCTR-OCH-14004176 . Registered on January 8, 2014.
在卵巢刺激过程中使用孕激素（P）可有效阻断卵巢储备功能正常女性的促黄体生成素（LH）峰，但在反应不良者中的效果尚未确定。本研究旨在探讨孕激素预处理的微刺激方案在反应不良者中的卵泡动力学。
总共204例卵巢储备功能减退的不孕女性被交替分配到醋酸甲羟孕酮（MPA）组或自然周期对照组。从卵泡早期开始每天给予MPA（10mg），如果血清促卵泡生成素（FSH）水平低于8.0mIU/ml，则在卵泡晚期添加低剂量的人绝经期促性腺激素（hMG）。当优势卵泡成熟时，使用100μg曲普瑞林和1000IU人绒毛膜促性腺激素（hCG）进行扳机注射，34 - 36小时后取卵。所有存活胚胎均冷冻保存以备后续冻融胚胎移植。自然周期体外受精用作对照。
与自然周期组相比，MPA组的排卵前卵泡更大（18.7±1.8mm对17.2±2.2mm），卵泡期更长（13.6±3.6天对12.3±3.2天），雌二醇峰值更高（403.88±167.16对265.26±122.16pg/ml），同时LH值更低（P<0.05）。自发性LH峰和过早排卵的发生率显著降低（分别为1.0%对50%；2%对10.8%；P<0.05）。MPA组收获的卵母细胞和存活胚胎数量多于自然周期组（P<0.05）。此外，MPA组的临床妊娠率略高于自然周期对照组，但差异不显著（11.8%对5.9%，P>0.05）。
本研究支持以下假设，即孕激素预处理的微刺激方案可实现优势卵泡的排卵控制，且对反应不良者的卵母细胞质量无不利影响。因此，孕激素预处理是克服反应不良者微刺激中过早排卵的一种有前景的方法。
中国临床试验注册中心注册号：ChiCTR - OCH - 14004176。于2014年1月8日注册。
