Lee Hwajeong, Choi Hyun Joung, Yang Kwang Moon, Kim Min Jung, Cha Sun Hwa, Yi Hyun Jeong
Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, College of Medicine, Dankook University, Seoul, Korea.
Department of Obstetrics and Gynecology, Maria Fertility Hospital, Seoul, Korea.
Obstet Gynecol Sci. 2018 Jan;61(1):102-110. doi: 10.5468/ogs.2018.61.1.102. Epub 2017 Dec 19.
We investigated whether luteal estrogen administration and an early follicular Gonadotropin-releasing hormone antagonist (E/G-ant) priming protocol improves clinical outcomes in poor responders to controlled ovarian stimulation for fertilization (IVF)-embryo transfer, and identified underlying mechanisms.
This restrospective study consisted of 65 poor responders who underwent the E/G-ant priming protocol. Sixty-four other poor responders undergoing conventional protocols without pretreatment were included as the control group. Clinical outcomes were compared between 2 groups.
The E/G-ant priming protocol group exhibited improvements over the control group in terms of the number of retrieved oocytes (3.58±2.24 vs. 1.70±1.45; =0.000), mature oocytes (2.68±2.11 vs. 1.65±1.23; =0.000), fertilized oocytes (2.25±1.74 vs. 1.32±1.26; =0.001), good embryos (1.62±0.91 vs. 1.14±0.90, =0.021). Day 3 follicle-stimulating hormone (FSH; 8.40±4.84 vs. 16.39±13.56; =0.000) and pre-ovulation progesterone levels (0.67 vs. 1.28 ng/mL; =0.016) were significantly higher in the control group than in the E/G-ant priming group. The overall rate of positive human chorionic gonadotropin tests was higher in the E/G-ant priming group than in the control group (32.3% vs.16.1%; =0.039). Also, clinical pregnancy rate (26.2% vs. 12.5%; =0.048) and the rate of live births (23.1% vs. 7.1%; =0.023) were significantly higher in the E/G-ant priming group than in the control group.
The E/G-ant priming protocol would lead to promising results in poor responders to IVF by suppressing endogenous FSH and by preventing premature luteinization.
我们研究了黄体期给予雌激素和卵泡期早期促性腺激素释放激素拮抗剂（E/G-ant）预处理方案是否能改善体外受精（IVF）-胚胎移植中卵巢低反应患者的临床结局，并确定其潜在机制。
这项回顾性研究纳入了65例接受E/G-ant预处理方案的卵巢低反应患者。另外64例未进行预处理而接受传统方案的卵巢低反应患者作为对照组。比较两组的临床结局。
E/G-ant预处理方案组在获卵数（3.58±2.24 vs. 1.70±1.45；P=0.000）、成熟卵母细胞数（2.68±2.11 vs. 1.65±1.23；P=0.000）、受精卵数（2.25±1.74 vs. 1.32±1.26；P=0.001）、优质胚胎数（1.62±0.91 vs. 1.14±0.90，P=0.021）方面均优于对照组。对照组第3天的促卵泡生成素（FSH；8.40±4.84 vs. 16.39±13.56；P=0.000）和排卵前孕酮水平（0.67 vs. 1.28 ng/mL；P=0.016）显著高于E/G-ant预处理组。E/G-ant预处理组人绒毛膜促性腺激素检测阳性的总体发生率高于对照组（32.3% vs.16.1%；P=0.039）。此外，E/G-ant预处理组临床妊娠率（26.2% vs. 12.5%；P=0.048）和活产率（23.1% vs. 7.1%；P=0.023）显著高于对照组。
E/G-ant预处理方案通过抑制内源性FSH和防止过早黄素化，可能会使IVF卵巢低反应患者获得较好的结果。
