Perovic Milan, Mikovic Zeljko, Zecevic Nebojsa, Zecevic Tatjana, Salovic Bojana, Dugalic Stefan, Mihailovic Mladen, Radakovic-Cosic Jovana, Soldatovic Ivan
Clinic for Gynecology and Obstetrics "Narodni Front", Kraljice Natalije 62, 11000, Belgrade, Serbia.
Faculty of Medicine, University of Belgrade, 8 Dr Subotića Street, 11000, Belgrade, Serbia.
Arch Gynecol Obstet. 2025 Jan;311(1):145-153. doi: 10.1007/s00404-024-07890-8. Epub 2024 Dec 25.
We aimed to evaluate if ovarian stimulation with individualized dosing of recombinant follicle-stimulating hormone (rec-FSH) with follitropin delta compared with standard gonadotropin dosing reduce occurrence of follicular asynchrony in women with polycystic ovary syndrome (PCOS) undergoing in vitro fertilization (IVF).
Matched case-control study analyzed occurrence of follicular growth asynchrony during ovarian stimulation and IVF outcomes in women with PCOS. Follicular growth was considered to be asynchronous when one or two leading follicles were at least 4 mm larger in diameter than the rest of the cohort on day 5 and 9 of stimulation. Analysis encompassed 44 women stimulated with individualized rec-FSH dosing, and 88 women treated with standard dosing. The patients were matched in terms of age, Anti-Müllerian hormone levels and body weight.
Early and late follicular asynchrony were present less frequently in individualized dosing compared to standard dosing group (4.5% vs 17%, p = 0.04 and 2.3% vs 37.5%, p < 0.001, on stimulation day 5 and 9, respectively). Multivariate logistic regression on follicular asynchrony revealed that individualized dosing significantly decreases the occurrence and chances for late follicular asynchrony (Odds Ratio 0.28, p < 0.001). Shorter duration of stimulation (9.6 vs 10.4 days, p = 0.001), lower total gonadotropin dose (1118 vs 1940 IU, p < 0.001), higher number of metaphase II oocytes (7.1 + 4.3 vs 5.4 ± 3.0, p = 0.001), good quality embryos (3.8 vs 2.0, p < 0.001), and implantation rates (31.0 vs 23.4, p = 0.04) were observed in the individualized dosing group.
Individualized rec-FSH dosing reduces asynchronous follicular growth and improves ovarian stimulation efficiency in women with PCOS undergoing IVF.
我们旨在评估与标准促性腺激素给药相比，多囊卵巢综合征（PCOS）患者在体外受精（IVF）过程中使用个性化剂量的重组促卵泡激素（rec-FSH）（达必佳）进行卵巢刺激是否能减少卵泡不同步的发生。
配对病例对照研究分析了PCOS患者在卵巢刺激期间卵泡生长不同步的发生情况以及IVF结局。当在刺激的第5天和第9天，一个或两个主导卵泡的直径比同组其他卵泡至少大4毫米时，卵泡生长被认为是不同步的。分析纳入了44例接受个性化rec-FSH给药刺激的女性和88例接受标准给药治疗的女性。患者在年龄、抗苗勒管激素水平和体重方面进行了匹配。
与标准给药组相比，个性化给药组早期和晚期卵泡不同步的发生率较低（分别在刺激第5天和第9天，4.5%对17%，p = 0.04；2.3%对37.5%，p < 0.001）。对卵泡不同步的多因素逻辑回归分析显示，个性化给药显著降低了晚期卵泡不同步的发生率和发生几率（优势比0.28，p < 0.001）。个性化给药组的刺激持续时间较短（9.6天对10.4天，p = 0.001），总促性腺激素剂量较低（1118 IU对1940 IU，p < 0.001），中期II级卵母细胞数量较多（7.1 ± 4.3对5.4 ± 3.0，p = 0.001），优质胚胎数量较多（3.8对2.0，p < 0.001），着床率较高（31.0对23.4，p = 0.04）。
在接受IVF的PCOS女性中，个性化rec-FSH给药可减少卵泡不同步生长并提高卵巢刺激效率。
