Reproductive Medicine Research Center, Sixth Affiliated Hospital of Sun Yat-sen University, NO.17, Shougouling Rd, Guangzhou, 510275, China.
Reproductive Medicine Research Center, Family Planning Special Hospital of Guangdong, Guangzhou, 510600, Guangdong, China.
Arch Gynecol Obstet. 2019 Apr;299(4):1201-1212. doi: 10.1007/s00404-019-05065-4. Epub 2019 Mar 9.
To evaluate the efficacy in suppressing the premature LH surge, embryo quality and pregnancy outcomes of progestin-primed ovarian stimulation (PPOS) protocols using medroxyprogesterone acetate versus utrogestan in women of all ages undergoing in vitro fertilization or intracytoplasmic sperm injection.
1188 patients were enrolled in the retrospective study, of which 1002 patients were treated with medroxyprogesterone acetate (M group) and recombinant follicle-stimulating hormone (r-FSH)simultaneously from day 3 of the cycle until trigger day, while 186 patients were treated with utrogestan (U group) and r-FSH instead. Viable embryos were cryopreserved for later transfer in both groups. Differences in baseline characteristics, ovarian stimulation characteristics, endocrinological characteristics, embryo development and clinical outcome between two groups were assessed. Statistical analyses were performed stratified by age and number of oocytes retrieved.
No significant differences were observed in the baseline characteristics, ovarian stimulation characteristics and clinical outcome of patients between groups. However, blastulation rate in the U group was significantly higher than that in the M group (49.4% vs. 32.9%, P < 0.001). During ovarian stimulation, LH levels remained steady in both groups. Higher percentage of premature LH surge was found in the U group (2.4% vs. 10.2%, P < 0.001), especially for patients aged more than 35 years or who had three oocytes or less retrieved.
Both the administration of medroxyprogesterone acetate and utrogestan in PPOS were sufficient to prevent an untimely LH rise, while for patients with poor ovarian response or aged above 35 years, MPA may result in a more satisfactory LH level. PPOS protocol using medroxyprogesterone acetate or utrogestan was comparable in terms of oocytes and pregnancy outcome, whereas the administration of utrogestan may result in an improved blastulation than medroxyprogesterone acetate, which needs further exploration.
评估醋酸甲羟孕酮与乌美孕酮在不同年龄段接受体外受精或卵胞浆内单精子注射的患者中进行孕激素预刺激卵巢刺激（PPOS）方案时抑制过早 LH 峰、胚胎质量和妊娠结局的疗效。
本回顾性研究纳入了 1188 名患者，其中 1002 名患者在周期第 3 天开始同时接受醋酸甲羟孕酮（M 组）和重组卵泡刺激素（r-FSH）治疗至扳机日，而 186 名患者接受乌美孕酮（U 组）和 r-FSH 治疗。两组均将可存活的胚胎冷冻以备以后移植。评估两组间患者的基线特征、卵巢刺激特征、内分泌特征、胚胎发育和临床结局的差异。按年龄和获卵数进行分层统计分析。
两组患者的基线特征、卵巢刺激特征和临床结局无显著差异。然而，U 组的囊胚形成率显著高于 M 组（49.4%比 32.9%，P<0.001）。在卵巢刺激期间，两组的 LH 水平均保持稳定。U 组发生过早 LH 峰的比例较高（2.4%比 10.2%，P<0.001），尤其是年龄大于 35 岁或获卵数为 3 个或更少的患者。
PPOS 方案中使用醋酸甲羟孕酮和乌美孕酮均可充分预防 LH 过早升高，而对于卵巢反应不良或年龄大于 35 岁的患者，MPA 可能导致更满意的 LH 水平。使用醋酸甲羟孕酮或乌美孕酮的 PPOS 方案在获卵数和妊娠结局方面相当，但乌美孕酮的给药可能会提高囊胚形成率，这需要进一步探索。
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