Department of Reproductive Medicine Center, the Affiliated Changzhou Maternal and Child Health Care Hospital of Nanjing Medical University, Changzhou, Jiangsu, China.
J Chin Med Assoc. 2019 Nov;82(11):845-848. doi: 10.1097/JCMA.0000000000000177.
Ovarian stimulation with clomiphene (CC) or progestin has been applied for patients with diminished ovarian reserve (DOR). However, it remains unclear which treatment confers greater benefits. This study aimed to compare the outcomes of progestin-primed ovarian stimulation (PPOS) protocol vs CC-primed ovarian stimulation (CPOS) in infertile women with DOR.
A before-and-after self-controlled study was conducted to retrospectively investigate the data from 50 infertile women with DOR, who failed to conceive in their first in vitro fertilization/intracytoplasmic sperm injection-frozen embryo transfer cycle when stimulated with CPOS, and switched to PPOS, in the Reproductive Medicine Center of Changzhou Maternal and Child Health Care Hospital.
Our results showed that PPOS significantly suppressed the luteinizing hormone (LH) surge and yielded more satisfactory results in patients with DOR, including increased number of retrieved oocytes, MII mature oocytes, normal fertilized oocytes, cleaved embryos, high-grade embryos, cryopreserved embryos, pregnancy rate, live-birth rate, and decreased miscarriage rates.
Our study demonstrated that compared with CPOS protocol, PPOS protocol could not only suppress the LH surge but also improved the quantity, particularly the quality of oocytes in patients with DOR, suggesting that PPOS treatment is more effective than CPOS for patients with DOR.
对于卵巢储备功能减退（DOR）患者，应用氯米芬（CC）或孕激素进行卵巢刺激。然而，哪种治疗方法更有益尚不清楚。本研究旨在比较孕激素预处理卵巢刺激（PPOS）方案与 CC 预处理卵巢刺激（CPOS）方案在 DOR 不孕患者中的疗效。
采用前后自身对照研究，回顾性分析常州妇幼保健院生殖医学中心 50 例因 DOR 导致首次体外受精/卵胞浆内单精子注射-冻融胚胎移植周期 CC 预处理卵巢刺激失败的不孕患者，转换为 PPOS 方案的临床资料。
PPOS 方案能显著抑制 LH 峰，对 DOR 患者更具优势，包括获卵数、MII 成熟卵数、正常受精卵数、卵裂胚胎数、优质胚胎数、冷冻胚胎数、妊娠率、活产率增加，流产率降低。
与 CPOS 方案相比，PPOS 方案不仅能抑制 LH 峰，而且能改善 DOR 患者的卵子数量和质量，提示 PPOS 治疗对 DOR 患者更为有效。
