University of Beira Interior - Faculty of Health Sciences, Covilhã, Portugal.
Reproductive Medicine Unit - University Hospital Center Cova da Beira, Covilhã, Portugal.
JBRA Assist Reprod. 2022 Aug 4;26(3):387-397. doi: 10.5935/1518-0557.20210077.
To understand which of the controlled ovarian stimulation (COS) protocols used in different patients are associated with greater amounts of oocytes retrieved.
The study population was divided into three groups, considering AMH and AFC to obtain the Ovarian Response Predictor Index (ORPI); they were grouped into: G1-Low Reserve (ORPI <0.5); G2-Normal Reserve (ORPI:0.5-0.9); and G3-High Reserve (ORPI≥0.9). 246 cycles were selected in which COS was used: recombinant FSH - follitropin alfa or beta (Protocol 1) or corifollitropin alfa (Protocol 2), both associated with urinary HMG and the GnRH antagonist, with the trigger performed using recombinant hCG or GnRH agonist.
The number of oocytes obtained was higher in protocol 1 in all groups, with higher counts seen in G1 than in G2 or G3. The number of days required in COS for protocol 2 was greater than for protocol 1 in all groups. The total dose of recombinant FSH alfa or beta / urinary HMG used in protocol 1 was inversely proportional to the ovarian reserve. The lower the ORPI, the greater the average number of international units administered. In protocol 2, there was a need to supplement with higher doses of urinary HMG when compared to protocol 1. The dosage of the GnRH antagonist was dependent on the number of COS days until the trigger was used. In obtaining MII oocytes, the percentages were similar regardless of the trigger used.
The use of follitropin leads to greater numbers of retrieved oocytes than corifollitropin alfa in all ORPIs. The dose of recombinant FSH used with urinary HMG increases inversely proportional to the ORPI value. The fixed dose of recombinant FSH deposit requires a sharp increase in the dose of urinary HMG.
了解不同患者使用的控制性卵巢刺激（COS）方案中，哪种方案与获取的卵母细胞数量较多相关。
研究人群分为三组，根据 AMH 和 AFC 获得卵巢反应预测指数（ORPI）；他们被分为：G1-低储备（ORPI<0.5）；G2-正常储备（ORPI：0.5-0.9）；G3-高储备（ORPI≥0.9）。选择了 246 个进行 COS 的周期：重组 FSH-卵泡刺激素阿尔法或贝塔（方案 1）或 corifollitropin alfa（方案 2），均与尿促性腺激素和 GnRH 拮抗剂联合使用，使用重组 hCG 或 GnRH 激动剂触发。
方案 1 在所有组中获得的卵母细胞数量都较高，G1 组的卵母细胞计数高于 G2 或 G3 组。方案 2 在所有组中进行 COS 所需的天数都长于方案 1。方案 1 中使用的重组 FSH 阿尔法或贝塔/尿促性腺激素的总剂量与卵巢储备呈反比。ORPI 越低，平均给予的国际单位数越多。在方案 2 中，与方案 1 相比，需要补充更高剂量的尿促性腺激素。GnRH 拮抗剂的剂量取决于使用触发前的 COS 天数。在获得 MII 卵母细胞时，无论使用哪种触发剂，百分比相似。
在所有 ORPI 中，使用 follitropin 比使用 corifollitropin alfa 获得的卵母细胞数量更多。与 ORPI 值成反比，使用尿促性腺激素的重组 FSH 剂量增加。固定剂量的重组 FSH 沉淀需要急剧增加尿促性腺激素的剂量。
