Zhu Xiuxian, Fu Yonglun
Department of Assisted Reproduction, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
Front Endocrinol (Lausanne). 2019 Jul 3;10:448. doi: 10.3389/fendo.2019.00448. eCollection 2019.
To investigate the feasibility of ovarian stimulation initiated in the late follicular phase using human menopausal gonadotropin (hMG) alone in ovulatory patients undergoing fertilization (IVF)/intracytoplasmic sperm injection (ICSI) treatments by comparison with that of the short gonadotropin-releasing hormone agonist (GnRH-a) protocol in terms of ovarian response, embryological characteristics, and pregnancy outcomes following frozen-thawed embryo transfer (FET) cycles. Retrospective cohort study. A university-affiliated tertiary hospital. 135 infertile women undergoing their first IVF/ICSI treatment with the freeze-all strategy. In the study group, ovarian stimulation was initiated in the late follicular phase using hMG alone, with the confirmation of dominant follicular diameter ≥ 14 mm, while a short GnRH-a protocol was adopted in the control group. Oocyte maturation was induced by human chorionic gonadotropin in both groups. All good quality embryos were cryopreserved for later transfer. The primary outcome was the incidence of premature luteinizing hormone (LH) surge. Secondary outcomes were the number of mature oocytes retrieved, good-quality embryo rate per oocyte retrieved, and clinical pregnancy rate following FET cycles. No premature LH surge was detected during ovarian stimulation in the study group. There was no statistically significant difference in the number of mature oocytes between the two groups (10 ± 5.6 in the study group vs. 8.51 ± 5.03 in the control group, = 0.11). Good-quality embryo rate per oocyte retrieved did not differ between the two groups: 40.18% (313/779) vs. 36.67% (253/690), = 0.167. Clinical pregnancy rate per transfer following FET was comparable between the two groups (61.33 vs. 52.5%, = 0.267). Our study shows that ovarian stimulation initiated in the late follicular phase using hMG alone may be a feasible alternative for normal-ovulatory women undergoing IVF/ICSI treatment with the freeze-all strategy.
通过比较卵泡晚期单独使用人绝经期促性腺激素（hMG）启动卵巢刺激与短期促性腺激素释放激素激动剂（GnRH-a）方案在排卵患者接受体外受精（IVF）/卵胞浆内单精子注射（ICSI）治疗时的卵巢反应、胚胎学特征以及冻融胚胎移植（FET）周期后的妊娠结局，来研究其可行性。回顾性队列研究。一所大学附属三级医院。135名采用全冻存策略进行首次IVF/ICSI治疗的不孕妇女。研究组在卵泡晚期单独使用hMG启动卵巢刺激，确认优势卵泡直径≥14mm，而对照组采用短期GnRH-a方案。两组均用人绒毛膜促性腺激素诱导卵母细胞成熟。所有优质胚胎均冷冻保存以备后期移植。主要结局是过早促黄体生成素（LH）峰的发生率。次要结局是获取的成熟卵母细胞数量、每个获取的卵母细胞的优质胚胎率以及FET周期后的临床妊娠率。研究组在卵巢刺激期间未检测到过早LH峰。两组之间成熟卵母细胞数量无统计学显著差异（研究组为10±5.6，对照组为8.51±5.０3，P = 0.11）。每个获取的卵母细胞的优质胚胎率在两组之间无差异：40.18%（313/779）对36.67%（253/690），P = 0.167。FET后每次移植的临床妊娠率在两组之间相当（61.33%对52.5%，P = 0.267）。我们的研究表明，对于采用全冻存策略进行IVF/ICSI治疗的正常排卵妇女，卵泡晚期单独使用hMG启动卵巢刺激可能是一种可行的替代方案。
