Reproduction Center, The Third Affiliated Hospital of ZhengZhou University, Zhengzhou, Henan, China.
Reprod Health. 2023 Aug 29;20(1):126. doi: 10.1186/s12978-023-01671-3.
Previous studies have reported that after laparoscopic cystectomy of ovarial endometrioma, the ovarian response to gonadotropin (Gn) significantly decreased. However, for patients with diminished ovarian reserve (DOR) after ovarian surgery, how to choose the most appropriate controlled ovarian hyperstimulation protocol has not been concluded. Compared with the traditional agonist regimen, the gonadotropin (Gn)-releasing hormone (GnRH) antagonist, microstimulation, and progestin-primed ovarian stimulation (PPOS) protocols are simple to operate and have a shorter cycle, which are often used in patients with DOR. So the purpose of our study is to compare the assisted reproductive outcomes of these three controlled ovarian hyperstimulation protocols in patients with DOR following laparoscopic cystectomy of ovarial endometrioma.
In this retrospective cohort study, 89 patients with DOR who had undergone in vitro fertilisation/intracytoplasmic sperm injection at the Department of Reproductive Medicine at the Third Affiliated Hospital of Zhengzhou University from 1 to 2018 to 31 December 2020 were included. According to the controlled ovarian hyperstimulation protocols employed, the patients were divided into GnRH antagonist (38 patients), PPOS (27 patients), and microstimulation (24 patients) groups. The basic data and clinical outcomes of the three groups were compared. The main outcome measure was the cumulative live birth rate.
No significant differences in the age of the female patients and their spouses and female patients' body mass index and basal endocrine levels (follicle-stimulating hormone and oestradiol) were noted among the three groups (P > 0.05). The GnRH antagonist group had higher antral follicle counts, greater endometrial thickness on the human chorionic Gn injection day, greater number of oocytes retrieved, and higher two pronuclear embryo counts than did the other two groups. However, the starting dosage of Gn was lower in the GnRH antagonist group than in the other two groups. The microstimulation group had a significantly higher oocyte output rate and high-quality embryo rate than did the other two groups (P < 0.05). No significant differences in the total dosage of Gn, cumulative pregnancy rate, cumulative live birth rate, viable embryo rate, and blastocyst formation rate were observed among the three groups (P > 0.05).
In conclusion, for patients aged under 40 years who experienced DOR after laparoscopic cystectomy of ovarial endometrioma, GnRH antagonist protocol and PPOS protocol can obtain better ovulation induction outcomes and cumulative live birth rate than microstimulation protocol, and are more suitable ovulation induction protocols.
既往研究报道腹腔镜卵巢子宫内膜异位囊肿剔除术后，卵巢对促性腺激素（Gn）的反应明显下降。然而，对于卵巢手术后卵巢储备功能降低（DOR）的患者，如何选择最合适的控制性卵巢刺激方案尚未得出结论。与传统的激动剂方案相比，促性腺激素（Gn）-释放激素（GnRH）拮抗剂、微刺激和孕激素预刺激卵巢刺激（PPOS）方案操作简单，周期较短，常用于 DOR 患者。因此，我们的研究目的是比较这三种控制性卵巢刺激方案在腹腔镜卵巢子宫内膜异位囊肿剔除术后 DOR 患者中的辅助生殖结局。
本回顾性队列研究纳入了 2018 年 1 月至 2020 年 12 月在郑州大学第三附属医院生殖医学科行体外受精/卵胞浆内单精子注射的 89 例 DOR 患者。根据控制性卵巢刺激方案将患者分为 GnRH 拮抗剂（38 例）、PPOS（27 例）和微刺激（24 例）组。比较三组的基本资料和临床结局。主要观察指标为累积活产率。
三组患者的女性患者及其配偶年龄、女性患者体质量指数和基础内分泌水平（卵泡刺激素和雌二醇）无显著差异（P＞0.05）。与其他两组相比，GnRH 拮抗剂组的窦卵泡计数更高，人绒毛膜 Gn 注射日子宫内膜更厚，获卵数更多，二原核胚胎数更高，但 GnRH 拮抗剂组的 Gn 起始剂量低于其他两组。微刺激组的卵母细胞输出率和优质胚胎率明显高于其他两组（P＜0.05）。三组患者的 Gn 总剂量、累积妊娠率、累积活产率、可利用胚胎率和囊胚形成率无显著差异（P＞0.05）。
综上所述，对于腹腔镜卵巢子宫内膜异位囊肿剔除术后发生 DOR 且年龄＜40 岁的患者，GnRH 拮抗剂方案和 PPOS 方案比微刺激方案能获得更好的促排卵结局和累积活产率，是更适合的促排卵方案。
