Bhor Sachin Ashok, Nakayama Kaname, Ono Hirofumi, Iwashita Toshiko, Kinoshita Koichi
Kinoshita Ladies Clinic, Otsu, Japan.
Clin Exp Reprod Med. 2023 Jun;50(2):132-140. doi: 10.5653/cerm.2022.05708. Epub 2023 May 19.
This study aimed to determine the effect of ovarian stimulation regimens on the top-quality blastocyst development rate and perinatal outcomes with the freeze-all strategy.
A retrospective comparative cohort analysis of 149 in vitro fertilization (IVF) cycles using the freeze-all strategy was conducted. The IVF cycles were stimulated with either a gonadotropin-releasing hormone antagonist or clomiphene citrate along with gonadotropin based on the patient's serum anti-Müllerian hormone level. Oocyte retrieval, fertilization, and embryo culture were performed following standard procedures. All good-quality blastocysts were cryopreserved and used for frozen-thawed embryo transfer (FET) in subsequent cycles. The fertilization, blastulation, and top-quality blastocyst development rates were calculated. The perinatal outcomes of FET cycles, gestational period, and birth weight were assessed.
The main outcome of this study was the top-quality blastocyst development rate, and the secondary outcomes were perinatal parameters (e.g., gestational period and birth weight) between the stimulation regimens. Despite the higher number of usable-quality embryos in the antagonist group, the blastocyst development rate remained comparable (p=0.105). Similarly, perinatal outcomes were comparable in subsequent FET cycles (p=0.538).
These findings suggest that the choice between antagonist and clomiphene citrate with gonadotropin as stimulation in controlled ovarian stimulation regimens may not affect the top-quality blastocyst development rate. The IVF outcomes (e.g., clinical pregnancy, miscarriage, and live birth rates) remained unaffected in subsequent FET cycles. Unlike fresh embryo transfer, the birth weight and gestational length were not associated with prior controlled ovarian stimulation regimens when the freeze-all strategy was used.
本研究旨在确定在全冻策略下，卵巢刺激方案对优质囊胚发育率和围产期结局的影响。
对149个采用全冻策略的体外受精（IVF）周期进行回顾性比较队列分析。根据患者血清抗苗勒管激素水平，IVF周期采用促性腺激素释放激素拮抗剂或枸橼酸氯米芬联合促性腺激素进行刺激。按照标准程序进行取卵、受精和胚胎培养。所有优质囊胚均进行冷冻保存，并在随后的周期中用于冻融胚胎移植（FET）。计算受精、囊胚形成和优质囊胚发育率。评估FET周期的围产期结局、妊娠期和出生体重。
本研究的主要结局是优质囊胚发育率，次要结局是刺激方案之间的围产期参数（如妊娠期和出生体重）。尽管拮抗剂组可用质量胚胎数量较多，但囊胚发育率仍相当（p = 0.105）。同样，随后FET周期的围产期结局相当（p = 0.538）。
这些发现表明，在控制性卵巢刺激方案中，拮抗剂与枸橼酸氯米芬联合促性腺激素作为刺激方案的选择可能不会影响优质囊胚发育率。在随后的FET周期中，IVF结局（如临床妊娠、流产和活产率）仍未受影响。与新鲜胚胎移植不同，采用全冻策略时，出生体重和妊娠期长度与先前的控制性卵巢刺激方案无关。
