Wu X, Chen Y, Zhou X, Zhang J, Li Y, Li X, Zhang X, Chen S
Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
Nan Fang Yi Ke Da Xue Xue Bao. 2021 Mar 25;41(3):412-417. doi: 10.12122/j.issn.1673-4254.2021.03.14.
To assess the effect and timing of human menopausal gonadotropin (HMG) supplementation in advancedage patients with diminished ovarian reserve (DOR) receiving gonadotropin-releasing hormone antagonist protocol.
A total of 682 patients with DOR aged over 35 years undergoing IVF-ET treatment were included in this study. All the patients underwent a GnRH antagonist protocol, and controlled ovarian stimulation was initiated on day 2-3 of the menstrual cycle with follicle stimulation hormone (FSH). According to the timing of HMG supplementation, the patients were divided into no supplementation group (=371) without HMG supplementation; early supplementation group (=139), in which daily HMG supplementation started on the first day till the trigger day; and late supplementation group (=172), in which HMG supplementation started when the leading follicle reached 10-14 mm in diameter and lasted until the trigger day. The pregnancy outcomes of the patients were compared among the 3 groups.
The 3 groups showed no significant difference in hCG trigger day E2 and P levels, endometrial thickness, or the number of follicles with comparable fertilization rate and cleavage rate (>0.05). Gn dose used was the lowest in no supplementation group, and the average number of oocytes retrieved was significantly smaller in early supplementation group than in late supplementation group ( < 0.05). The mean number of mature oocytes and embryos available were significantly higher in late supplementation group than in early supplementation group ( < 0.05). The clinical pregnancy rate of fresh embryo transfer cycle was significantly higher in late supplementation group than in no supplementation group (27.7% 45.1%, < 0.05), but the implantation rate, early miscarriage rate, heterotopic pregnancy rate and live birth rate were comparable among the 3 groups (>0.05). No significant differences were found among the 3 groups in the implantation rate, clinical pregnancy rate, early miscarriage rate, heterotopic pregnancy rate or live birth rate of the first frozen-thawed embryo transfer cycle with a freeze-all strategy (>0.05).
HMG supplementation in the middle and late follicular phase can improve the outcomes of controlled ovarian hyperstimulation and increase the clinical pregnancy rate of fresh embryo transfer cycle in advanced-age patients with DOR undergoing GnRH antagonist protocol.
评估在接受促性腺激素释放激素拮抗剂方案的高龄卵巢储备功能减退（DOR）患者中补充人绝经期促性腺激素（HMG）的效果及时机。
本研究纳入了682例年龄超过35岁接受体外受精 - 胚胎移植（IVF - ET）治疗的DOR患者。所有患者均采用促性腺激素释放激素（GnRH）拮抗剂方案，在月经周期的第2 - 3天开始使用促卵泡生成素（FSH）进行控制性卵巢刺激。根据补充HMG的时机，将患者分为未补充组（n = 371），不补充HMG；早期补充组（n = 139），从第一天开始每日补充HMG直至扳机日；晚期补充组（n = 172），当主导卵泡直径达到10 - 14 mm时开始补充HMG并持续至扳机日。比较3组患者的妊娠结局。
3组在人绒毛膜促性腺激素（hCG）扳机日的雌二醇（E2）和孕酮（P）水平、子宫内膜厚度或卵泡数量方面无显著差异，受精率和卵裂率相当（P>0.05）。未补充组使用的促性腺激素（Gn）剂量最低，早期补充组回收的平均卵母细胞数量显著少于晚期补充组（P<0.05）。晚期补充组的成熟卵母细胞和可用胚胎的平均数量显著高于早期补充组（P<0.05）。晚期补充组新鲜胚胎移植周期的临床妊娠率显著高于未补充组（27.7% 对45.1%，P<0.05），但3组之间的着床率、早期流产率、异位妊娠率和活产率相当（P>0.05）。在采用全胚冷冻策略的首次冻融胚胎移植周期中，3组在着床率、临床妊娠率、早期流产率、异位妊娠率或活产率方面未发现显著差异（P>0.05）。
在卵泡中期和晚期补充HMG可改善控制性卵巢过度刺激的结局，并提高接受GnRH拮抗剂方案的高龄DOR患者新鲜胚胎移植周期的临床妊娠率。
