Center for Reproductive Medicine, Dongfang Hospital, Xiamen University (900TH Hospital of Joint Logistics Support Force), Fuzhou, China.
Center for Reproductive Medicine, Fuzong Clinical College, Fujian Medical University (900TH Hospital of Joint Logistics Support Force), West Second Ring North Road, Fuzhou, 350025, Fujian Province, China.
J Ovarian Res. 2024 May 27;17(1):114. doi: 10.1186/s13048-024-01415-2.
The key to enhancing the efficacy of antagonistic regimens in pregnancy is to better synchronize follicular growth during cycles of controlled ovarian stimulation (COS), especially in patients with diminished ovarian reserve (DOR). During in vitro fertilization-embryo transfer (IVF-ET) treatment, luteal phase estrogen pretreatment may enhance follicular development synchronization and yield of mature oocytes. However, the effect of estrogen pretreatment in DOR patients with elevated basal follicle-stimulating hormone (FSH) levels has not been well studied.
We retrospectively analyzed the clinical data of patients with elevated basal FSH levels and DOR (401 cycles) who underwent IVF/intracytoplasmic monosperm injection (ICSI)-assisted conception. Both groups were treated with a flexible gonadotropin-releasing hormone (GnRH) antagonist regimen and were further divided into two groups according to whether they received luteal estrogen pretreatment. There were 79 patients in the estrogen pretreatment group and 322 patients in the control group. On the second day of the menstrual cycle, gonadotropin (Gn) stimulation of the ovaries was initiated. The general characteristics, clinical, biological parameters and outcomes of the two groups were compared.
The basic profiles of the two groups were similar (P > 0.05). More patients in the pretreatment group showed FSH rebound after gonadotropin (Gn) initiation, resulting in a significantly higher number of Gn days and total Gn than those in the control group (P < 0.05). There was no statistically significant difference in the number of days of antagonist use, follicle output rate (FORT), number of metaphase II(MII)eggs obtained, number of Two pronuclei (2PN) fertilized, number of D quality embryos, blastocyst formation rate, fresh embryo clinical pregnancy rate, cumulative pregnancy rate, and non-transferable embryo rate between the two groups (P > 0.05).
The use of luteal phase estrogen pretreatment in patients with elevated basal FSH combined with DOR resulted in high FSH levels after the release of negative feedback, which was detrimental to early follicular growth, did not increase the follicular output rate, may have increased the use and duration of controlled ovarian stimulation drugs, and did not increase the number of eggs gained or improve clinical outcomes.
提高拮抗方案在妊娠中的疗效的关键是更好地在控制性卵巢刺激（COS）周期中同步卵泡生长，特别是在卵巢储备减少（DOR）的患者中。在体外受精-胚胎移植（IVF-ET）治疗中，黄体期雌激素预处理可能增强卵泡发育同步和成熟卵母细胞的产量。然而，在基础卵泡刺激素（FSH）水平升高的 DOR 患者中，雌激素预处理的效果尚未得到很好的研究。
我们回顾性分析了接受 IVF/胞浆内单精子注射（ICSI）辅助受孕的基础 FSH 水平升高和 DOR 患者（401 个周期）的临床数据。两组均采用灵活的促性腺激素释放激素（GnRH）拮抗剂方案治疗，并根据是否接受黄体期雌激素预处理进一步分为两组。预处理组 79 例，对照组 322 例。在月经周期的第二天开始卵巢的促性腺激素（Gn）刺激。比较两组的一般特征、临床、生物学参数和结局。
两组的基本特征相似（P＞0.05）。预处理组中有更多患者在启动 Gn 后出现 FSH 反弹，导致 Gn 天数和总 Gn 明显高于对照组（P＜0.05）。拮抗剂使用天数、卵泡输出率（FORT）、获得的中期 II（MII）卵子数、二倍体（2PN）受精数、D 级胚胎数、囊胚形成率、新鲜胚胎临床妊娠率、累积妊娠率和不可转移胚胎率无统计学差异两组之间（P＞0.05）。
基础 FSH 升高合并 DOR 患者黄体期雌激素预处理后，释放负反馈导致 FSH 水平升高，不利于早期卵泡生长，并未增加卵泡输出率，可能增加控制性卵巢刺激药物的使用和持续时间，并未增加获得的卵子数量或改善临床结局。
