Tian Li-Feng, Tan Jun, Zou Yang, Su Qiong, Li You, Xu Ding-Fei, Wu Qiong-Fang
Reproductive Medicine Center, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, Jiangxi Province, China.
Key Laboratory of Women's Reproductive Health of Jiangxi Province, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, Jiangxi, China.
Arch Med Sci. 2019 Sep;15(5):1294-1300. doi: 10.5114/aoms.2019.85145. Epub 2019 May 16.
Controlled ovarian hyperstimulation (COH) is essential for artificial reproduction technology (ART). This study aimed to evaluate the effects of a mild starting dosage of r-FSH ovarian stimulation after the modified prolonged GnRH-a down-regulation protocol for COH on the clinical outcomes in normal ovarian responders undergoing fertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET).
In the retrospective study, the patients were separated into two groups according to the starting dosage of r-FSH: a mild dosage group (75 IU ≤ r-FSH < 150 IU, = 858) and a conventional dosage group (150 IU ≤ r-FSH ≤ 225 IU, = 535). Data were collected from clinical records. The baseline characteristics and clinical outcomes were compared between the two groups.
Although the duration of r-FSH treatment was a little longer in the mild dosage group, the total r-FSH dosage and the cost of ovarian stimulation were significantly lower than those in the conventional dosage group. Furthermore, compared to the conventional dosage group, the number of retrieved oocytes was also lower in the mild dosage group, whereas the rates of two pronuclei (2PN) fertilized oocytes and good-quality embryos were remarkable higher. The implantation rate, clinical pregnancy rate and live birth rate were significantly higher in the mild dosage group. There was no difference in early miscarriages rate, incidence of moderate and severe ovarian hyper-stimulation syndrome (OHSS) or incidence of ectopic pregnancy between the two groups.
The modified prolonged GnRH-a pituitary down-regulation regimen combined with mild r-FSH starting dosage improved IVF/ICSI outcomes and reduced the financial cost in normal ovarian responders.
控制性卵巢刺激（COH）对辅助生殖技术（ART）至关重要。本研究旨在评估在改良的延长GnRH-a降调节方案用于COH后，采用低起始剂量重组促卵泡生成素（r-FSH）进行卵巢刺激对接受体外受精/卵胞浆内单精子注射-胚胎移植（IVF/ICSI-ET）的正常卵巢反应者临床结局的影响。
在这项回顾性研究中，根据r-FSH的起始剂量将患者分为两组：低剂量组（75 IU≤r-FSH＜150 IU, n = 858）和传统剂量组（150 IU≤r-FSH≤225 IU, n = 535）。从临床记录中收集数据。比较两组的基线特征和临床结局。
虽然低剂量组r-FSH治疗时间稍长，但总r-FSH剂量和卵巢刺激费用显著低于传统剂量组。此外，与传统剂量组相比，低剂量组获取的卵母细胞数量也较少，而双原核（2PN）受精卵母细胞和优质胚胎的比例显著更高。低剂量组的种植率、临床妊娠率和活产率显著更高。两组之间的早期流产率、中重度卵巢过度刺激综合征（OHSS）发生率或异位妊娠发生率无差异。
改良的延长GnRH-a垂体降调节方案联合低起始剂量r-FSH可改善正常卵巢反应者的IVF/ICSI结局并降低经济成本。
