Zhou Ruiqiong, Dong Mei, Huang Li, Wang Songlu, Wang Zhaoyi, Xu Liqing, Zhang Xiqian, Liu Fenghua
Center for Reproductive Medicine, Guangdong Women and Children Hospital, Guangzhou 511400, Guangdong Province, China.
J Clin Endocrinol Metab. 2025 Feb 18;110(3):611-623. doi: 10.1210/clinem/dgae847.
Progestins have recently been used as an alternative for gonadotropin-releasing hormone (GnRH) analogues to prevent premature luteinizing hormone surge due to the application of vitrification technology. However, the long-term efficacy and safety of a progestin-primed ovarian stimulation (PPOS) regimen, including oocyte competence, cumulative live birth rate (LBR), and offspring outcomes, remain to be investigated.
To compare cumulative LBR of preimplantation genetic testing (PGT) cycles between a PPOS regimen and GnRH analogues.
This was a retrospective cohort study at a tertiary academic medical center. A total of 967 patients with good prognosis were categorized into 3 groups: 478 patients received a long GnRH agonist, 248 patients received a GnRH antagonist, and 250 received a PPOS regimen. Medroxyprogesterone 17-acetate was the only progestin used in the PPOS regimen. The primary outcome was cumulative LBR. Secondary outcomes included time to live birth, cumulative rates of biochemical and clinical pregnancy and pregnancy loss, and perinatal outcomes.
The PPOS regimen was negatively associated with cumulative LBR compared with GnRH antagonists and GnRH agonists (28.4% vs 40.7% and 42.7%). The average time to live birth was significantly shorter with GnRH antagonists than with the PPOS regimen. The cumulative biochemical and clinical pregnancy rates were also lower in the PPOS regimen than GnRH analogues, while cumulative pregnancy loss rates were similar across groups. Furthermore, the number and ratio of good-quality blastocysts were significantly reduced in the PPOS regimen compared with GnRH analogues. In addition, perinatal outcomes were comparable across 3 groups.
A PPOS regimen may adversely affect cumulative LBR and blastocyst quality in women with good prognosis compared with GnRH analogues in PGT cycles.
孕激素最近已被用作促性腺激素释放激素（GnRH）类似物的替代品，以防止因应用玻璃化技术导致的过早促黄体生成素激增。然而，孕激素预处理卵巢刺激（PPOS）方案的长期疗效和安全性，包括卵母细胞能力、累积活产率（LBR）和子代结局，仍有待研究。
比较PPOS方案与GnRH类似物在植入前基因检测（PGT）周期中的累积LBR。
这是一项在三级学术医疗中心进行的回顾性队列研究。总共967例预后良好的患者被分为3组：478例患者接受长效GnRH激动剂，248例患者接受GnRH拮抗剂，250例患者接受PPOS方案。醋酸甲羟孕酮是PPOS方案中使用的唯一孕激素。主要结局是累积LBR。次要结局包括活产时间、生化和临床妊娠及妊娠丢失的累积发生率，以及围产期结局。
与GnRH拮抗剂和GnRH激动剂相比，PPOS方案与累积LBR呈负相关（28.4%对40.7%和42.7%）。GnRH拮抗剂的平均活产时间明显短于PPOS方案。PPOS方案的累积生化和临床妊娠率也低于GnRH类似物，而各组间的累积妊娠丢失率相似。此外，与GnRH类似物相比，PPOS方案中优质囊胚的数量和比例显著降低。此外，3组的围产期结局相当。
在PGT周期中，与GnRH类似物相比，PPOS方案可能对预后良好的女性的累积LBR和囊胚质量产生不利影响。
