Department of Medical and Surgical Sciences for Children & Adults, University of Modena and Reggio Emilia, 41123 Modena, Italy.
Clinica Eugin Modena, Modena, Italy.
Hum Reprod. 2020 Jun 1;35(6):1325-1331. doi: 10.1093/humrep/deaa068.
Does the prevalence of euploid blastocysts differ between patients treated with progestin primed ovarian stimulation (PPOS) and those treated with conventional ovarian stimulation?
The numbers of blastocysts and euploid blastocysts per patient and the number of euploid embryos per injected oocyte are similar for patients undergoing progestin-primed ovarian stimulation and for those undergoing conventional ovarian stimulation with GnRH antagonist.
New approaches to ovarian stimulation have been developed based on the use of drugs administrable by mouth instead of via injections. Attention has been dedicated to progestins to block the LH surge. Previous data regarding the number of oocytes retrieved and the number of good-quality embryos generated in PPOS have demonstrated similar outcomes when compared to conventional ovarian stimulation, even if some concerns regarding the quality of embryos have been advanced.
STUDY DESIGN, SIZE, DURATION: This is a prospective non-inferiority age-matched case-control study. In a period of 6 months, a total of 785 blastocysts from 1867 injected oocytes obtained from 192 patients were available for analysis.
PARTICIPANTS/MATERIALS, SETTING, METHODS: Infertile women undergoing IVF and preimplanation genetic testing (PGT) cycles were included. Forty-eight patients were treated with PPOS, and for each of them three age-matched historical controls (n = 144) treated with a GnRH antagonist protocol were selected. PGT was performed according to next-generation sequencing technology.
Basal characteristics were similar in the two groups; a substantial similarity of the main outcome measures in the two treatment groups has also been found. The rate of formation of euploid blastocysts per oocyte was 21% in both the two treatment groups. The percentage of patients with euploid embryos and the total number of euploid blastocysts per patient (median and interquartile range, IQR) in the PPOS group were 38.7 (25.5-52.9) and 2 (1.3-3.1), respectively. These figures were not significantly different in women treated with the GnRH antagonist protocol i.e. 42 (28-53.8) and 2.1 (1.3-2.9), respectively.
LIMITATIONS, REASONS FOR CAUTION: This was a case-control study which may limit the reliability of the main findings.
Our results encourage the use of PPOS, especially for oocyte donation, for fertility preservation and for patients in which total freezing of embryos is foreseen, for those expected to be high responders or candidates for preimplantation genetic testing. However, studies aiming to investigate the effect of PPOS on the live birth rate are warranted.
STUDY FUNDING/COMPETING INTEREST(S): None.
接受孕激素预处理的卵巢刺激（PPOS）和接受常规卵巢刺激的患者之间，囊胚的整倍体率是否存在差异？
接受孕激素预处理的卵巢刺激和接受 GnRH 拮抗剂的常规卵巢刺激的患者，每位患者的囊胚数量和整倍体囊胚数量以及每个注射卵母细胞的整倍体胚胎数量相似。
已经开发了新的卵巢刺激方法，基于使用可口服而不是注射的药物。人们关注孕激素以阻断 LH 激增。关于 PPOS 中获得的卵母细胞数量和产生的优质胚胎数量的先前数据表明，与常规卵巢刺激相比，结果相似，尽管已经提出了一些关于胚胎质量的担忧。
研究设计、规模、持续时间：这是一项前瞻性非劣效性年龄匹配的病例对照研究。在 6 个月的时间内，从 192 名患者的 1867 个注射卵母细胞中获得了 785 个囊胚，可用于分析。
参与者/材料、设置、方法：纳入接受 IVF 和植入前遗传检测（PGT）周期的不孕妇女。48 名患者接受 PPOS 治疗，为每位患者选择了 3 名年龄匹配的历史对照（n=144）接受 GnRH 拮抗剂方案治疗。PGT 是根据下一代测序技术进行的。
两组的基本特征相似；两组的主要治疗结果也存在实质性相似性。每个卵母细胞形成整倍体囊胚的比率在两组中均为 21%。PPOS 组的整倍体胚胎患者比例和每位患者的整倍体囊胚总数（中位数和四分位距，IQR）分别为 38.7（25.5-52.9）和 2（1.3-3.1）。接受 GnRH 拮抗剂方案治疗的女性中，这些数字分别为 42（28-53.8）和 2.1（1.3-2.9），差异无统计学意义。
局限性、谨慎的原因：这是一项病例对照研究，可能会限制主要发现的可靠性。
我们的结果鼓励使用 PPOS，特别是对于卵子捐赠、生育力保存以及预计胚胎将全部冷冻的患者，对于那些预期为高反应者或接受植入前遗传检测的患者。然而，需要研究旨在调查 PPOS 对活产率的影响。
研究资金/竞争利益：无。
