以患者为导向的策略中的卵巢刺激，包括个体化卵母细胞数量-4类别；拮抗剂方案与短效激动剂方案对比
Ovarian Stimulation in Patient-oriented Strategies Encompassing Individualised Oocyte Number-4 Category; Antagonist versus Short-agonist Protocols.
作者信息
Al-Hussaini Tarek K, Mohamed Ahmed Aboelfadle, Askar Ayman, Abden Ahmed A, Othman Yousra M, Hussein Reda S
机构信息
Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Asyut, Egypt.
出版信息
J Hum Reprod Sci. 2023 Jul-Sep;16(3):212-217. doi: 10.4103/jhrs.jhrs_72_23. Epub 2023 Sep 29.
BACKGROUND
Recently POSEIDON (Patient-Oriented Strategies Encompassing Individualized Oocyte Number) classification was proposed to categorize patients with expected poor response to conventional stimulation. Searching for the ideal management of poor responders in IVF is still an active research area.
AIMS
This study compares GnRH-antagonist and GnRH-agonist short protocols in ICSI cycles for the POSEIDON-4 group.
SETTINGS AND DESIGN
This retrospective study was conducted in a tertiary infertility unit between January 2016 and December 2020.
MATERIALS AND METHODS
Infertile women who met the criteria for POSEIDON 4 group and underwent fresh ICSI-ET in using GnRH-antagonist and GnRH-agonist short protocols was performed. POSEIDON-4 includes patients ≥ 35 years with poor ovarian reserve markers; AFC < 5 and AMH < 1.2 ng/ml.
STATISTICAL ANALYSIS USED
Numerical variables were compared between both groups by student's t test and Mann Whitney test when appropriate. Chi-square test used to compare categorical variables. Multivariate logistic regression models were utilized to adjust for the effect of the different study confounders on live birth rate.
RESULTS
One hundred ninety fresh ICSI cycles were analyzed. Of the total cohort, 41.6 % (79) patients pursued antagonist protocol compared to 58.4% (111) underwent short agonist protocol. Fresh embryo transfer was accomplished in 55.7 % (44/79) vs. 61.3 % (68/111), = 0.44 in antagonist vs. short protocol respectively. Cycle cancellation due to poor ovarian response was encountered in (32.9%vs. 27.9%, = 0.50) in the antagonist and short groups, whereas no good-quality embryos were developed after ovum pickup in 11.4% vs. 10.8%, P>0.05. Comparable total gonadotropins dose, number of retrieved and mature oocytes, and good-quality embryos were found in both groups. Likewise, clinical pregnancy rate was not different for the antagonist and short groups [11/79 (13.9%) vs. 20/111 (18%), = 0.45]. The live birth rate was comparable between both groups (8.9% vs. 10.8%, = 0.659) for antagonist and short groups respectively. No significant impact for the protocol type on live birth rate was revealed after adjusting to cycle confounders in multivariate analysis (OR: 0.439, 95%CI 0.134-1.434, = 0.173).
CONCLUSION
This study shows comparable pregnancy outcomes for antagonist and short-agonist protocols in IVF/ICSI cycles for POSEIDON-4 category.
背景
最近提出了POSEIDON（涵盖个体化卵母细胞数量的以患者为导向的策略）分类法，用于对预计对传统刺激反应不良的患者进行分类。寻找体外受精中反应不良患者的理想管理方法仍是一个活跃的研究领域。
目的
本研究比较了POSEIDON-4组在卵胞浆内单精子注射（ICSI）周期中使用促性腺激素释放激素（GnRH）拮抗剂和GnRH激动剂短方案的情况。
设置与设计
本回顾性研究于2016年1月至2020年12月在一家三级不孕不育治疗中心进行。
材料与方法
对符合POSEIDON 4组标准并采用GnRH拮抗剂和GnRH激动剂短方案进行新鲜ICSI胚胎移植（ICSI-ET）的不孕妇女进行研究。POSEIDON-4包括年龄≥35岁且卵巢储备指标不佳的患者；窦卵泡计数（AFC）<5且抗缪勒氏管激素（AMH）<1.2 ng/ml。
所用统计分析方法
数值变量在适当情况下通过学生t检验和曼-惠特尼检验在两组之间进行比较。卡方检验用于比较分类变量。采用多因素逻辑回归模型来调整不同研究混杂因素对活产率的影响。
结果
分析了190个新鲜ICSI周期。在整个队列中，41.6%（79例）患者采用拮抗剂方案，而58.4%（111例）患者采用短激动剂方案。新鲜胚胎移植率在拮抗剂方案组为55.7%（44/79），短方案组为61.3%（68/111），拮抗剂方案与短方案组分别为0.44。拮抗剂组和短方案组因卵巢反应不良导致的周期取消率分别为32.9%对27.9%，P = 0.50，而取卵后未发育出优质胚胎的比例分别为11.4%对10.8%，P>0.05。两组的总促性腺激素剂量、获卵数、成熟卵母细胞数和优质胚胎数相当。同样，拮抗剂组和短方案组的临床妊娠率无差异[11/79（13.9%）对20/111（18%），P = 0.45]。拮抗剂组和短方案组的活产率相当（8.9%对10.8%，P = 0.659）。多因素分析中调整周期混杂因素后，未发现方案类型对活产率有显著影响（比值比：0.439，95%置信区间0.134 - 1.434，P = 0.173）。
结论
本研究表明，在POSEIDON-4类患者的体外受精/ICSI周期中，拮抗剂方案和短激动剂方案的妊娠结局相当。
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