Eftekhar Maryam, Mohammadi Banafsheh, Khani Parisa, Lahijani Maryam Mortazavi
Department of Obstetrics and Gynecology, Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
Abortion Research Center, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
Int J Reprod Biomed. 2020 Jun 30;18(6):465-470. doi: 10.18502/ijrm.v13i6.7287. eCollection 2020 Jun.
Poor ovarian response management is a complex and controversial issue in the field of reproductive medicine.
The aim of this study was to apply double stimulation in the same cycle in unexpected poor responders in POSEIDON classification group 1, sub group 2a and compare assisted reproductive technology outcomes between luteal phase and follicular phase ovarian stimulation.
In this cross-sectional study, 10 women with age 35 yr, antral follicle count 5, and anti-müllerian hormone 1.2 ng/mL were enrolled. All participants received conventional antagonist protocol in the follicular phase and only the cycles with retrieved oocytes 4 in this phase included. The luteal phase ovarian stimulation was initiated from the day of first oocytes retrieval by 300 IU of human menopausal gonadotropin / day. When dominant follicles amounted to 14 mm in mean diameter, 0.25 mg/day of gonadotropin-releasing hormone antagonist was initiated and 10,000 IU human chorionic gonadotropin was injected when at least two follicles with a mean diameter of 17 mm were observed. Oocyte retrieval was carried out 34-36 hr following human chorionic gonadotropin injection. Finally, a comparison was made between the two phase in terms of the number of retrieved oocytes as well as the number of obtained embryos and fertilization rates.
Numbers of retrieved oocytes (p = 0.004), mature oocytes (p = 0.016), and embryos (p = 0.013) was significantly higher in luteal phase in compared with follicular phase. Quality of embryos was similar in two phases.
Double stimulation protocol can increase number of retrieved oocytes in unexpected PORs.
在生殖医学领域，对卵巢反应不良的管理是一个复杂且存在争议的问题。
本研究旨在对波塞冬分类第1组、2a亚组中意外的卵巢低反应者在同一周期内进行双重刺激，并比较黄体期和卵泡期卵巢刺激的辅助生殖技术结局。
在这项横断面研究中，纳入了10名年龄35岁、窦卵泡计数5个且抗苗勒管激素1.2 ng/mL的女性。所有参与者在卵泡期接受常规拮抗剂方案，仅纳入该期回收卵母细胞≥4个的周期。黄体期卵巢刺激从首次取卵日开始，每天给予300 IU人绝经期促性腺激素。当优势卵泡平均直径达到14 mm时，开始每天给予0.25 mg促性腺激素释放激素拮抗剂，当观察到至少两个平均直径为17 mm的卵泡时，注射10,000 IU人绒毛膜促性腺激素。在注射人绒毛膜促性腺激素后34 - 36小时进行取卵。最后，比较两个阶段回收的卵母细胞数量、获得的胚胎数量以及受精率。
与卵泡期相比，黄体期回收的卵母细胞数量（p = 0.004）、成熟卵母细胞数量（p = 0.016）和胚胎数量（p = 0.013）显著更高。两个阶段胚胎质量相似。
双重刺激方案可增加意外卵巢低反应者回收的卵母细胞数量。
