Kahyaoglu Inci, Dogru Hatice Y, Kaplanoglu Iskender, Ozgu-Erdinc Ayse Seval, Dilbaz Serdar, Mollamahmutoglu Leyla
Department of Obstetrics and Gynecology, Etlik Zübeyde Hanım Women's Health Training and Research Hospital, University of Health Sciences, Ankara, Turkey.
Department of Obstetrics and Gynecology, Gaziosmanpaşa University Faculty of Medicine, Tokat, Turkey.
J Hum Reprod Sci. 2021 Oct-Dec;14(4):400-405. doi: 10.4103/jhrs.jhrs_75_21. Epub 2021 Dec 31.
Despite the great advances in Assisted Reproductive Technologies (ART), management of poor responders has remained a great challenge. Gonadotropin releasing hormone antagonist (GnRH-ant) has been offered as a patient friendly protocol. In the literature, conflicting data exists about the effect of the GnRH-ant starting day on cycle outcomes.
The aim of this study is to evaluate the effect of GnRH-ant starting day on cycle outcomes of patients with poor ovarian response defined by Bologna criteria.
This retrospective cohort study was conducted at an ART clinic of a tertiary hospital.
A total of 361 cycles using flexible GnRH-ant, 195 in Group A (GnRH-ant administered before day 6 of stimulation) and 166 cycles in Group B (GnRH-ant started on or after day 6), were selected retrospectively for the study.
Statistical analysis of data was carried out using using IBM SPSS Statistics Software (20.0, SPSS Inc., Chicago, IL, USA). Independent samples t-test and Mann-Whitney U test were used to analyze the variables.
Total antral follicle count was significantly higher in Group A compared to Group B ( = 0.009). Duration of stimulation was significantly shorter ( < 0.01) and total dose of gonadotropin used was lower in Group A when compared to Group B ( < 0.01). While higher number of oocytes was retrieved from Group A ( = 0.037), no between-group differences were observed in number of mature oocytes, fertilized oocytes, clinical pregnancy rate or ongoing pregnancy rate (OPR) per embryo transfer ( > 0.05).
Early GnRH-ant start may point out a favourable response to ovarian stimulation in poor responders. However, clinical or OPRs were not different from the late GnRH-ant start group.
尽管辅助生殖技术（ART）取得了巨大进展，但对反应不良者的管理仍然是一个巨大挑战。促性腺激素释放激素拮抗剂（GnRH-ant）已被作为一种对患者友好的方案。在文献中，关于GnRH-ant起始日对周期结局的影响存在相互矛盾的数据。
本研究的目的是评估GnRH-ant起始日对根据博洛尼亚标准定义的卵巢反应不良患者周期结局的影响。
本回顾性队列研究在一家三级医院的ART诊所进行。
回顾性选择了总共361个使用灵活GnRH-ant的周期，其中A组195个周期（GnRH-ant在刺激第6天之前给药），B组166个周期（GnRH-ant在第6天或之后开始使用）用于研究。
使用IBM SPSS统计软件（20.0，SPSS公司，美国伊利诺伊州芝加哥）对数据进行统计分析。采用独立样本t检验和曼-惠特尼U检验分析变量。
A组的窦卵泡总数显著高于B组（P = 0.009）。与B组相比，A组的刺激持续时间显著更短（P < 0.01），使用的促性腺激素总剂量更低（P < 0.01）。虽然A组回收的卵母细胞数量更多（P = 0.037），但在每个胚胎移植的成熟卵母细胞数量、受精卵母细胞数量、临床妊娠率或持续妊娠率（OPR）方面未观察到组间差异（P > 0.05）。
早期开始使用GnRH-ant可能表明反应不良者对卵巢刺激有良好反应。然而，临床妊娠率或持续妊娠率与晚期开始使用GnRH-ant组没有差异。
