在预防不孕女性过早出现促黄体生成素峰及辅助生殖技术结局方面，孕激素方案与促性腺激素释放激素拮抗剂方案的比较：一项随机对照试验

Comparison of progesterone protocol versus gonadotropin-releasing hormone antagonist protocol in terms of preventing premature LH surge and assisted reproductive technology outcome in infertile women: a randomized controlled trial.

作者信息

Jabarpour Masoome, Pouri Sara, Aleyasin Ashraf, Shabani Nashtaei Maryam, Najafian Aida

机构信息

Department of Anatomy, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.

Department of Obstetrics and Gynecology, Shariati Hospital, Tehran University of Medical Sciences, Jalal-e-Al-e-Ahmad Hwy, Tehran, 1411713135, Iran.

出版信息

Arch Gynecol Obstet. 2024 May;309(5):1999-2008. doi: 10.1007/s00404-024-07387-4. Epub 2024 Feb 29.

DOI:10.1007/s00404-024-07387-4

PMID:38421423

Abstract

INTRODUCTION

Progesterone can be used instead of GnRH agonists and antagonists in order to avert a premature LH surge during controlled ovarian stimulation (COS) protocol. Nonetheless, there is limited knowledge regarding its utilization. Thus, this study compared the effects of progesterone and GnRH antagonists (GnRH-ant) on premature LH surges and assisted reproductive technology (ART) results in infertile women undergoing ART.

MATERIALS AND METHODS

In this clinical trial, the progesterone protocol (study group) and GnRH-ant protocol (control group) were tested in 300 infertile individuals undergoing IVF/ICSI. The main outcome was the number of oocytes retrieved. The secondary outcomes included premature LH rise/surge, the quantity of follicles measuring ≥ 10 and 14 mm, oocyte maturity and fertilization rate, the number of viable embryos, high-quality embryo rate and pregnancy outcomes.

RESULTS

The study group exhibited a statistically significant increase in the number of retrieved oocytes, follicles measuring 14 mm or greater, and viable embryos compared to the control group (P < 0.05). The study group also increased oocyte maturity, chemical pregnancy rate, and clinical pregnancy rate (P < 0.05). Both groups had similar mean serum LH, progesterone, and E2 levels on trigger day. The control group had more premature LH rise than the study group, although this difference was not statistically significant.

CONCLUSION

In conclusion, it can be stated that the progesterone protocol and the GnRH-ant protocol exhibit similar rates of sudden premature LH surge in infertile patients. However, it is important to note that the two regiments differ in their outcomes in ART.

TRIAL REGISTRATION

This study was retrospectively registered in the Iranian website ( www.irct.ir ) for clinical trials registration ( http://www.irct.ir : IRCT-ID: IRCT20201029049183N, 2020-11-27).

摘要

引言

在控制性卵巢刺激（COS）方案中，可使用孕激素替代促性腺激素释放激素（GnRH）激动剂和拮抗剂，以避免过早出现促黄体生成素（LH）峰。然而，关于其使用的知识有限。因此，本研究比较了孕激素和GnRH拮抗剂（GnRH-ant）对接受辅助生殖技术（ART）的不孕妇女过早LH峰及ART结果的影响。

材料与方法

在这项临床试验中，对300例接受体外受精/卵胞浆内单精子注射（IVF/ICSI）的不孕个体进行了孕激素方案（研究组）和GnRH-ant方案（对照组）测试。主要结局是获取的卵母细胞数量。次要结局包括过早LH升高/峰、直径≥10和14毫米的卵泡数量、卵母细胞成熟度和受精率、存活胚胎数量、优质胚胎率及妊娠结局。

结果

与对照组相比，研究组获取的卵母细胞数量、直径14毫米及以上的卵泡数量和存活胚胎数量有统计学显著增加（P<0.05）。研究组还提高了卵母细胞成熟度、化学妊娠率和临床妊娠率（P<0.05）。两组在扳机日的平均血清LH、孕激素和雌二醇（E2）水平相似。对照组过早LH升高的情况比研究组更多，尽管这种差异无统计学意义。