Department of Obstetrics and Gynecology, Koç University Hospital, Istanbul, Turkey.
Dünya IVF Center, Kyrenia, Northern Cyprus Turkish Republic.
Fertil Steril. 2019 Oct;112(4):677-683. doi: 10.1016/j.fertnstert.2019.06.009. Epub 2019 Jul 29.
To determine whether a flexible progestin primed ovarian stimulation (fPPOS) protocol is effective for preventing premature ovulation.
Retrospective cohort study.
Private assisted reproduction center.
PATIENT(S): Eighty-seven oocyte donors and 191 recipients of fresh oocytes.
INTERVENTION(S): Each donor was stimulated with a flexible gonadotropin-releasing hormone (GnRH) antagonist protocol in one cycle and with the new fPPOS protocol in the other, within a period of 6 months. FSH was started on cycle day 2-3, and 0.25 mg/day GnRH antagonist or 10 mg/day medroxyprogesterone acetate (MPA) was started on stimulation day 7 or when the leading follicle reached 14 mm, whichever came first.
MAIN OUTCOME MEASURE(S): Duration of stimulation, gonadotropin consumption, duration of GnRH antagonist or MPA administration, number of metaphase II oocytes, and pregnancy rates in fresh oocyte recipients.
Duration of stimulation was 11 (10-11) days in both groups. Total gonadotropin consumption was similar. Pituitary suppression was started on day 7 and lasted for 5 days in each group. There were no premature ovulations in any group. The fPPOS yielded a significantly higher number of cumulus oocyte complexes than GnRH antagonist cycles (33 [21-39] vs. 26 [18-36], respectively). Likewise, the fPPOS generated significantly more metaphase II oocytes than GnRH antagonist cycles (24 [17-34] vs. 21 [15-28], respectively). Recipients of fresh oocytes from fPPOS and GnRH antagonist cycles had similar cleavage, blastulation, implantation, and live birth/ongoing pregnancy rates (50% vs. 48.6%).
CONCLUSION(S): FPPOS with MPA seems to be an effective choice for preventing premature ovulation in women undergoing ovarian stimulation without compromising oocyte quality.
确定灵活的孕激素预处理卵巢刺激（fPPOS）方案是否能有效预防早发性排卵。
回顾性队列研究。
私立辅助生殖中心。
87 名卵母细胞供体和 191 名新鲜卵母细胞受者。
每位供体在 6 个月内的一个周期中接受灵活的促性腺激素释放激素（GnRH）拮抗剂方案刺激，另一个周期中接受新的 fPPOS 方案刺激。FSH 于周期第 2-3 天开始，GnRH 拮抗剂或醋酸甲羟孕酮（MPA）于刺激第 7 天或主导卵泡达到 14mm 时开始，以先发生者为准，起始剂量分别为 0.25mg/天和 10mg/天。
刺激持续时间、促性腺激素用量、GnRH 拮抗剂或 MPA 给药时间、MⅡ 卵母细胞数和新鲜卵母细胞受者的妊娠率。
两组刺激持续时间均为 11（10-11）天。总促性腺激素用量相似。两组均于第 7 天开始垂体抑制，持续 5 天。两组均无早发性排卵。fPPOS 组获得的卵丘-卵母细胞复合物数量明显多于 GnRH 拮抗剂组（分别为 33[21-39]和 26[18-36]）。同样，fPPOS 组产生的 MⅡ 卵母细胞数也明显多于 GnRH 拮抗剂组（分别为 24[17-34]和 21[15-28]）。接受新鲜卵母细胞的受者，fPPOS 组和 GnRH 拮抗剂组的卵裂率、囊胚形成率、着床率和活产/持续妊娠率相似（分别为 50%和 48.6%）。
在不影响卵母细胞质量的情况下，使用 MPA 的 fPPOS 似乎是预防卵巢刺激中早发性排卵的有效选择。
