孕激素预处理卵巢刺激或 GnRH 拮抗剂方案治疗不同年龄患者的非整倍体比较。

Comparison of aneuploidy for patients of different ages treated with progestin-primed ovarian stimulation or GnRH antagonist protocols.

机构信息

Reproductive Medicine Center, Sichuan Provincial Women's and Children's Hospital, the Affiliated Women's and Children's Hospital of Chengdu Medical College, Chengdu, Sichuan 610045, China; Department of Obstetrics and Gynecology, Suining Central Hospital, Suining, Sichuan 629000, China.

Reproductive Medicine Center, Sichuan Provincial Women's and Children's Hospital, the Affiliated Women's and Children's Hospital of Chengdu Medical College, Chengdu, Sichuan 610045, China; Chengdu Medical College, Chengdu, Sichuan 610500, China.

出版信息

Reprod Biomed Online. 2024 Nov;49(5):104349. doi: 10.1016/j.rbmo.2024.104349. Epub 2024 Jul 3.

DOI:10.1016/j.rbmo.2024.104349

PMID:39213984

Abstract

RESEARCH QUESTION

Does euploidy status differ among patients of different ages treated with progestin-primed ovarian stimulation (PPOS) or gonadotrophin releasing hormone antagonist (GnRH-a) protocols?

DESIGN

Patients undergoing PGT-A (n = 418; 440 cycles) were enrolled and grouped according to female age (<35 years and ≥35 years). Protocols were as follows: PPOS: <35 years (n = 131; 137 cycles); ≥35 years (n = 72; 80 cycles); GnRH-a: <35 years (n = 149; 152 cycles); ≥35 years (n = 66; 71 cycles).

RESULTS

For cycles treated with PPOS in the older group, rates of euploid blastocyst per metaphase Ⅱ oocyte (15.48% versus 10.47%) and per biopsied blastocyst (54.94% versus 40.88%) were significantly higher than those treated with GnRH-a (P < 0.05). The mosaic rate per biopsied blastocyst was significantly lower for cycles treated with PPOS than cycles treated with GnRH-a (8.64% versus 23.36%) (P < 0.001). In the younger group, no significant difference was found between treatments (P > 0.05). In older and younger groups, the drug to inhibit LH surge was cheaper for cycles treated with PPOS compared with GnRH-a (P < 0.001). Generalized estimation equations based on binomial distribution female age and euploidy rate was significantly negatively correlated for all participants (β -0.109, 95% CI -0.183 to -0.035, P = 0.004), and between GnRH-a protocol (reference: PPOS) and the euploidy rate in the older group (β -0.126, 95% CI -0.248 to -0.004, P = 0.042). Multiple logistic regression indicated that ovarian stimulation protocol was not associated with ongoing pregnancy rate (OR 0.652, 95% CI 0.358 to 1.177; P = 0.14).

CONCLUSIONS

PPOS is suitable for patients undergoing PGT-A, particularly older patients for the higher euploid blastocyst rate attained by PPOS protocol.

摘要

研究问题

在接受孕激素预处理的卵巢刺激（PPOS）或促性腺激素释放激素拮抗剂（GnRH-a）方案治疗的不同年龄的患者中，整倍体状态是否不同？

设计

入组并根据女性年龄（<35 岁和≥35 岁）将接受 PGT-A 的患者分为组。方案如下：PPOS：<35 岁（n=131；137 个周期）；≥35 岁（n=72；80 个周期）；GnRH-a：<35 岁（n=149；152 个周期）；≥35 岁（n=66；71 个周期）。

结果

对于年龄较大组中接受 PPOS 治疗的周期，每个中期 II 期卵母细胞的整倍体囊胚率（15.48%比 10.47%）和每个活检囊胚的整倍体囊胚率（54.94%比 40.88%）均显著高于 GnRH-a 治疗组（P<0.05）。与 GnRH-a 治疗组相比，接受 PPOS 治疗的周期的活检囊胚的镶嵌率明显较低（8.64%比 23.36%）（P<0.001）。在年轻组中，治疗之间无显著差异（P>0.05）。在年龄较大和较小的组中，与 GnRH-a 相比，接受 PPOS 治疗的周期的抑制 LH 激增的药物更便宜（P<0.001）。基于二项式分布的广义估计方程的女性年龄和整倍体率呈显著负相关（所有参与者的β-0.109，95%CI-0.183 至-0.035，P=0.004），以及 GnRH-a 方案（参考：PPOS）与年龄较大组的整倍体率之间（β-0.126，95%CI-0.248 至-0.004，P=0.042）。多因素逻辑回归表明卵巢刺激方案与持续妊娠率无关（OR 0.652，95%CI 0.358 至 1.177；P=0.14）。