Key Laboratory of Reproductive Genetics (Ministry of Education), Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Front Endocrinol (Lausanne). 2022 Jan 24;12:801026. doi: 10.3389/fendo.2021.801026. eCollection 2021.
To assess and compare the feasibility of progestin-primed ovarian stimulation (PPOS) protocol with mild stimulation protocol for advanced age women with diminished ovarian reserve (DOR) undergoing their first fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycle.
Patients aged ≥35 years and DOR undergoing their first IVF/ICSI cycle were enrolled in this retrospective cohort study: 139 and 600 patients underwent the PPOS and mild stimulation protocols, respectively. The primary outcomes were cumulative clinical pregnancy rate (CCPR) and cumulative live birth rate (CLBR). The secondary outcomes were the number of oocytes retrieved and top-quality embryos.
There was nearly no significant difference of baseline characteristics between the two groups. Although a greater amount of total gonadotropin (1906.61 ± 631.04 IU vs. 997.72 ± 705.73 IU, <0.001) and longer duration of stimulation (9 (10-7) vs. 6 (8-4), <0.001) were observed in the PPOS group, the number of retrieved oocytes (3 (6-2) vs. 2 (4-1), <0.001) and top-quality embryos (1 (2-0) vs. 1 (2-0), =0.038) was greater in the PPOS group than the mild stimulation group. Meanwhile, the incidence of premature luteinizing hormone (LH) surge rate was significantly lower in the PPOS group (0.7% vs.8.3%, =0.001) than the mild stimulation group. However, there was no significant difference in conservative CCPR, conservative CLBR, optimistic CCPR, and optimistic CLBR between the two groups (all >0.05). A multivariate logistic regression model showed significant positive effects of the number of retrieved oocytes and number of top-quality embryos on conservative CCPR (OR=1.236, 95%CI: 1.048-1.456, =0.012, OR=2.313, 95%CI: 1.676-3.194, <0.001) and conservative CLBR (OR=1.250, 95%CI: 1.036-1.508, =0.020, OR=2.634, 95%CI: 1.799-3.857, <0.001) respectively, while significant negative effects of age were identified for conservative CCPR (OR=0.805, 95%CI: 0.739-0.877, <0.001) and conservative CLBR (OR=0.797, 95%CI: 0.723-0.879, <0.001).
The PPOS protocol is an effective alternative to the mild stimulation protocol for advanced age patients with DOR, as it provides comparable reproductive outcomes and better control of premature LH surge. Further, more oocytes and top-quality embryos were obtained in the PPOS group, which had a positive association with conservative CCPR and CLBR.
评估和比较孕激素预处理卵巢刺激（PPOS）方案与轻度刺激方案在高龄伴有卵巢储备功能降低（DOR）的患者中进行首次体外受精（IVF）/卵胞浆内单精子注射（ICSI）周期的可行性。
本回顾性队列研究纳入了年龄≥35 岁且 DOR 接受首次 IVF/ICSI 周期的患者：分别有 139 例和 600 例患者接受了 PPOS 和轻度刺激方案。主要结局是累积临床妊娠率（CCPR）和累积活产率（CLBR）。次要结局是获卵数和优质胚胎数。
两组患者的基线特征几乎没有显著差异。尽管 PPOS 组使用了更多的总促性腺激素（1906.61±631.04IU 比 997.72±705.73IU，<0.001）和更长的刺激时间（9（10-7）比 6（8-4），<0.001），但 PPOS 组的获卵数（3（6-2）比 2（4-1），<0.001）和优质胚胎数（1（2-0）比 1（2-0），=0.038）更多。同时，PPOS 组的早发性黄体生成素（LH）峰发生率显著低于轻度刺激组（0.7%比 8.3%，=0.001）。然而，两组的保守性 CCPR、保守性 CLBR、乐观性 CCPR 和乐观性 CLBR 均无显著差异（均>0.05）。多变量逻辑回归模型显示，获卵数和优质胚胎数对保守性 CCPR（OR=1.236，95%CI：1.048-1.456，=0.012，OR=2.313，95%CI：1.676-3.194，<0.001）和保守性 CLBR（OR=1.250，95%CI：1.036-1.508，=0.020，OR=2.634，95%CI：1.799-3.857，<0.001）有显著的正效应，而年龄对保守性 CCPR（OR=0.805，95%CI：0.739-0.877，<0.001）和保守性 CLBR（OR=0.797，95%CI：0.723-0.879，<0.001）有显著的负效应。
PPOS 方案是高龄伴有 DOR 患者的一种有效的轻度刺激方案替代方案，因为它提供了相似的生殖结局，并且更好地控制了早发性 LH 峰。此外，PPOS 组获得了更多的卵母细胞和优质胚胎，这与保守性 CCPR 和 CLBR 呈正相关。
