Kamiya Ladies Clinic, 2-1, Nishi 2, Kita 3, Chuo-ku, Sapporo, Hokkaido, 060-0003, Japan.
Kamiya Ladies Clinic, 2-1, Nishi 2, Kita 3, Chuo-ku, Sapporo, Hokkaido, 060-0003, Japan.
Reprod Biol. 2021 Mar;21(1):100470. doi: 10.1016/j.repbio.2020.100470. Epub 2020 Dec 14.
Dienogest (DNG) is an oral progestin effective for the treatment of symptomatic endometriosis, such as reduction of endometrial lesion and control of pain intensity. Progestin-primed ovarian stimulation (PPOS) is a new controlled ovarian hyperstimulation (COH) regimen, and several reports have shown that dydrogesterone (DYG) is an appropriate progestin for PPOS. The purpose of this study was to evaluate the efficacy of DNG in patients undergoing PPOS during COH in comparison with DYG. This was a prospective, cohort, parallel-group, non-inferiority trial of 150 women with endometriosis undergoing assisted reproductive technology between February 2018 and May 2020 at the single fertility center. The assignment to each protocol was based on the optimal treatment for each patient. Patients taking DNG 2 mg continuously were assigned in the DNG group(n = 73). The other patients were allocated in DYG group(n = 77). All viable embryos were cryopreserved for subsequent transfer. The main outcome measures were the mature oocyte and fertilization rates. During this study, no premature LH surge was detected. A smaller number of oocytes were retrieved in the DNG group than in the DYG group (6.18 ± 3.60 vs. 9.85 ± 5.77); however, the rate of mature oocytes was significantly higher in the DNG group than in the DYG group (89.1 % vs. 78.9 %). The fertilization rate was comparable between two groups. Therefore, patients taking DNG for PPOS can continue endometriosis treatment and obtain good-quality embryos during COH. Further prospective randomized-controlled trial should be performed to confirm of this novel strategy of DNG.
地诺孕素（DNG）是一种有效的治疗子宫内膜异位症的口服孕激素，可减少子宫内膜病变并控制疼痛强度。孕激素预处理卵巢刺激（PPOS）是一种新的控制性卵巢过度刺激（COH）方案，有几项报告显示地屈孕酮（DYG）是 PPOS 的合适孕激素。本研究旨在比较 DNG 与 DYG 在 COH 期间进行 PPOS 治疗的疗效。这是一项前瞻性、队列、平行组、非劣效性试验，纳入了 2018 年 2 月至 2020 年 5 月在单一生育中心接受辅助生殖技术的 150 例子宫内膜异位症患者。每个方案的分组是基于每位患者的最佳治疗方案。连续服用 DNG 2mg 的患者被分入 DNG 组（n=73）。其余患者被分入 DYG 组（n=77）。所有可存活的胚胎均被冷冻以备后续移植。主要观察指标是成熟卵母细胞和受精率。在本研究中，未检测到过早的 LH 激增。DNG 组的获卵数少于 DYG 组（6.18±3.60 vs. 9.85±5.77）；然而，DNG 组的成熟卵母细胞率明显高于 DYG 组（89.1% vs. 78.9%）。两组的受精率相当。因此，接受 PPOS 的 DNG 治疗的患者可以在 COH 期间继续治疗子宫内膜异位症并获得高质量的胚胎。需要进一步进行前瞻性随机对照试验来证实这种 DNG 的新策略。
