Almana General Hospital, IVF unit, Eastern Provence, Saudi Arabia.
Department of Obstetrics and Gynecology, Faculty of medicine, Al-Azhar University, Cairo, Egypt.
JBRA Assist Reprod. 2023 Sep 12;27(3):381-385. doi: 10.5935/1518-0557.20220064.
Several strategies have been proposed for ovarian stimulation in older women, such as using an increased daily dose of gonadotropins (300-450 IU per day) with GnRH agonist (long or micro dose flare protocols), or using GnRH antagonist protocols. The objective of this study is to compare the efficacy of flexible GnRH antagonist protocol and GnRH agonist flare - pituitary block protocols for ovarian stimulation in women above 40 years old undergoing IVF.
This study was performed between January 2016 and February 2019. One hundred and fourteen women aged between 40 and 42 years who underwent IVF were divided into two groups; group I were treated by Flexible GnRH antagonist protocol (Antagonist group, n=68); and group II were treated by Flare GnRH agonist protocol (Flare group, n=46).
Patients treated with the antagonist protocol had a significantly lower cancellation rate when compared with patients treated with flare agonist protocol (10.3% vs. 21.7%, p value 0.049). The other parameters evaluated did not show statistically significant differences.
Our finding showed that both Flexible antagonist and Flare agonist protocols had comparable outcomes, with lower cycle cancellation rates for older patients treated with the antagonist protocol.
针对高龄女性的卵巢刺激，已经提出了几种策略，例如使用增加的促性腺激素日剂量（每天 300-450IU）与 GnRH 激动剂（长或微剂量flare 方案），或使用 GnRH 拮抗剂方案。本研究的目的是比较灵活的 GnRH 拮抗剂方案和 GnRH 激动剂 flare-垂体阻断方案在接受 IVF 的 40 岁以上女性中的卵巢刺激效果。
这项研究于 2016 年 1 月至 2019 年 2 月进行。将 114 名年龄在 40 至 42 岁之间的接受 IVF 的女性分为两组；组 I 采用灵活 GnRH 拮抗剂方案（拮抗剂组，n=68）；组 II 采用 flare GnRH 激动剂方案（flare 组，n=46）。
与 flare 激动剂方案相比，拮抗剂方案治疗的患者取消率显著降低（10.3% vs. 21.7%，p 值=0.049）。评估的其他参数没有显示出统计学上的显著差异。
我们的发现表明，对于高龄患者，拮抗剂方案和 flare 激动剂方案的结局相当，但拮抗剂方案的周期取消率较低。
