İsrafilova Güler, Şükür Yavuz Emre, Özkavukcu Sinan, Sönmezer Meltem Aksu, Atabekoğlu Cem Somer, Özmen Batuhan, Berker Bülent, Aytaç Ruşen, Koç Acar, Sönmezer Murat
Department of Obstetrics and Gynecology, Ankara University Faculty of Medicine, Ankara, Turkey.
Department of Obstetrics and Gynecology, Center for Human Reproduction and Infertility, Ankara University School of Medicine, Dikimevi, 06100, Ankara, Turkey.
Reprod Sci. 2021 Aug;28(8):2200-2207. doi: 10.1007/s43032-020-00412-2. Epub 2021 Jan 6.
Conventional assisted reproductive technology (ART) cycles may delay cancer treatment and compromise survival, and also increase patients' psychological burden as a result of delayed chemotherapy. The aim of this study was to compare the success rates of random start and conventional start GnRH antagonist protocols in terms of oocyte and embryo outputs in cancer patients. Data of 111 patients with a newly diagnosed cancer who underwent ART for fertility preservation at a university-based infertility clinic between January 2010 and September 2019 were reviewed. The study group underwent random start controlled ovarian hyperstimulation (RS-COH) and the control group underwent conventional start COH (CS-COH). The main outcome measures were the number of total oocytes, MII oocytes, and embryo yield. A total of 46 patients (41.5%) underwent RS-COH and 65 (58.5%) underwent CS-COH. Baseline characteristics were similar between the groups. The most common cancer type in both groups was breast cancer (60.9% vs. 52.3%, respectively). The median duration of stimulation was significantly longer in RS-COH than in CS-COH (12 vs. 10 days; P = 0.005). The median number of MII oocytes was significantly higher in RS-COH than in CS-COH (7 vs. 5 oocytes, respectively; P = 0.020). The MII/AFC ratio was significantly higher in the RS-COH group compared to the CS-COH group (74% and 57% respectively; p = 0.02). In the linear regression analyses, RS-COH protocol did not have a significant impact on MII/AFC (standardized ß coefficient - 0.514; P = 0.289 {adjusted R for the model = 0.779}), oocyte yield (standardized ß coefficient - 0.070; P = 0.829 {adjusted R for the model = 0.840}), and MII rate (standardized ß coefficient - 0.504; P = 0.596 {adjusted R for the model = 0.271}). In conclusion, RS-COH protocol is as effective as CS-COH protocols for fertility preservation in cancer patients.
传统辅助生殖技术（ART）周期可能会延迟癌症治疗并影响生存率，同时由于化疗延迟还会增加患者的心理负担。本研究的目的是比较随机启动和传统启动的GnRH拮抗剂方案在癌症患者卵母细胞和胚胎产出方面的成功率。回顾了2010年1月至2019年9月期间在一所大学附属不孕不育诊所接受ART以保留生育功能的111例新诊断癌症患者的数据。研究组接受随机启动控制性卵巢刺激（RS-COH），对照组接受传统启动COH（CS-COH）。主要观察指标为总卵母细胞数、MII期卵母细胞数和胚胎产量。共有46例患者（41.5%）接受RS-COH，65例（58.5%）接受CS-COH。两组的基线特征相似。两组中最常见的癌症类型均为乳腺癌（分别为60.9%和52.3%）。RS-COH的中位刺激持续时间显著长于CS-COH（12天对10天；P = 0.005）。RS-COH的MII期卵母细胞中位数显著高于CS-COH（分别为7个和5个卵母细胞；P = 0.020）。与CS-COH组相比，RS-COH组的MII/AFC比值显著更高（分别为74%和57%；p = 0.02）。在线性回归分析中，RS-COH方案对MII/AFC（标准化β系数 -0.514；P = 0.289 {模型调整R = 0.779}）、卵母细胞产量（标准化β系数 -0.070；P = 0.829 {模型调整R = 0.840}）和MII率（标准化β系数 -0.504；P = 0.59
