Liu Luxin, Xu Yanwen, Huang Jia, Zhou Canquan
Reproductive Medicine Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510080, China; Guangdong Provincial Key Laboratory of Reproductive Medicine, Guangzhou, Guangdong, 510080, China.
Reproductive Medicine Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510080, China; Guangdong Provincial Key Laboratory of Reproductive Medicine, Guangzhou, Guangdong, 510080, China.
Eur J Obstet Gynecol Reprod Biol. 2021 Feb;257:88-94. doi: 10.1016/j.ejogrb.2020.12.024. Epub 2020 Dec 15.
To compare the efficacy of gonadotropin-releasing hormone antagonist versus gonadotropin-releasing hormone agonist long protocol in women belonging to POSEIDON groups 3 and 4.
A total of 380 patients with expected low ovarian response [antral follicle count < 5 and/or anti-Müllerian hormone < 1.2 ng/mL] were studied retrospectively. The efficiency of the gonadotropin-releasing hormone antagonist protocol and the gonadotropin-releasing hormone agonist long protocol was compared in patients from POSEIDON group 3 (age < 35 years) and group 4 (age ≥ 35 years), respectively. The primary outcome was the cumulative live birth rate. All patients underwent complete cycles of in vitro fertilization/intracytoplasmic sperm injection for the first time from January 2016 to June 2019.
In POSEIDON group 4, age, anti-Müllerian hormone, initial gonadotropin dose and induction protocols were significantly correlated with cumulative live birth by multivariate regression analysis. The optimum cut-off value of anti-Müllerian hormone for prediction of cumulative live birth was 0.785 by receiver operating characteristic analysis. Patients with higher anti-Müllerian hormone levels (anti-Müllerian hormone ≥ 0.785 ng/mL) who received the gonadotropin-releasing hormone agonist long protocol achieved significantly higher cumulative live birth rate than who received the gonadotropin-releasing hormone antagonist protocol, whereas no significant difference in cumulative live birth rate of the two protocols was found in patients with low anti-Müllerian hormone levels (anti-Müllerian hormone < 0.785 ng/mL). In POSEIDON group 3, only body mass index was significantly correlated with cumulative live birth. There was no correlation between cumulative live birth and induction protocols.
Patients with higher anti-Müllerian hormone levels from POSEIDON group 4 are more likely to benefit from the gonadotropin-releasing hormone agonist long protocol than the gonadotropin-releasing hormone antagonist protocol.
比较促性腺激素释放激素拮抗剂方案与促性腺激素释放激素激动剂长方案对POSEIDON 3组和4组女性的疗效。
回顾性研究了380例预期卵巢反应低下的患者（窦卵泡计数<5个和/或抗苗勒管激素<1.2 ng/mL）。分别比较了POSEIDON 3组（年龄<35岁）和4组（年龄≥35岁）患者中促性腺激素释放激素拮抗剂方案和促性腺激素释放激素激动剂长方案的有效性。主要结局是累积活产率。所有患者在2016年1月至2019年6月首次接受了完整周期的体外受精/卵胞浆内单精子注射。
在POSEIDON 4组中，通过多因素回归分析，年龄、抗苗勒管激素、初始促性腺激素剂量和诱导方案与累积活产显著相关。通过受试者工作特征分析，预测累积活产的抗苗勒管激素的最佳截断值为0.785。抗苗勒管激素水平较高（抗苗勒管激素≥0.785 ng/mL）且接受促性腺激素释放激素激动剂长方案的患者的累积活产率显著高于接受促性腺激素释放激素拮抗剂方案的患者，而抗苗勒管激素水平较低（抗苗勒管激素<0.785 ng/mL）的患者中，两种方案的累积活产率无显著差异。在POSEIDON 3组中，仅体重指数与累积活产显著相关。累积活产与诱导方案之间无相关性。
POSEIDON 4组中抗苗勒管激素水平较高的患者，相较于促性腺激素释放激素拮抗剂方案，更可能从促性腺激素释放激素激动剂长方案中获益。
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