Qin Xi, Fan Li, Luo Yuxing, Deng Zhibing, Zeng Zhonghong, Jiang Xiaoling, Yang Yihua
Reproductive Medicine Center, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
Reproductive Medicine Center, Guangzhou Women and Children's Hospital Medical Center Liuzhou Hospital, Liuzhou, Guangxi, China.
Arch Gynecol Obstet. 2025 Apr;311(4):1181-1193. doi: 10.1007/s00404-024-07918-z. Epub 2025 Feb 13.
Information on the impact of Progestin-primed ovarian stimulation (PPOS) protocol on embryo euploid status and preimplantation genetic testing for aneuploidy (PGT-A) outcomes is limited compared with other ovarian stimulation protocols. We conducted a retrospective cohort study and a meta-analysis to evaluate the application value of the PPOS protocol in PGT-A cycles.
In the cohort study, we retrospectively analyzed 962 ovarian stimulation cycles, including 413 cycles of PPOS protocol, 327 cycles of gonadotropin-releasing hormone antagonist (GnRH-ant) protocol, and 222 cycles of GnRH agonist (GnRH-a) protocol. In the meta-analysis, we searched PubMed, Embase, Cochrane Library, Web of Science, Sinomed, CNKI, Wanfang and VIP databases as well as clinical trial registration websites. Pooled or narrative analyses were performed on embryo and pregnancy outcomes according to whether baseline characteristics were balanced.
In our retrospective study, compared to the GnRH agonist protocol, patients receiving the PPOS and GnRH antagonist protocols were older, and there was a significant decrease in the number of antral follicles, Anti-Mullerian hormone (AMH) levels, stimulation duration, gonadotropin (Gn) dosage, as well as the number of retrieved oocytes and euploid blastocysts. Regression analysis showed that the ovarian stimulation protocol was not associated with the number of euploid blastocysts or the rate of euploid blastocysts per biopsy. There were no significant differences in the rates of biochemical pregnancy, clinical pregnancy, premature birth, live birth, or miscarriage per embryo transfer among the three groups. The meta-analysis included data from seven studies. There were no significant differences in stimulation duration, Gn dosage, number of oocytes retrieved, number of euploid blastocysts, euploid blastocyst rate, clinical pregnancy rate, or live birth rate between PPOS protocol and GnRH antagonist protocol, but the abortion rate of PPOS protocol decreased significantly.
Current findings indicate that the PPOS protocol is comparable to other ovarian stimulation protocols in embryo euploid status or pregnancy outcomes and may be an attractive option in PGT-A cycles, which needs to be validated in more well-designed RCTs and long-term follow-ups.
与其他卵巢刺激方案相比，关于孕激素预处理卵巢刺激（PPOS）方案对胚胎整倍体状态及非整倍体植入前基因检测（PGT-A）结局影响的信息有限。我们进行了一项回顾性队列研究和一项荟萃分析，以评估PPOS方案在PGT-A周期中的应用价值。
在队列研究中，我们回顾性分析了962个卵巢刺激周期，包括413个PPOS方案周期、327个促性腺激素释放激素拮抗剂（GnRH-ant）方案周期和222个促性腺激素释放激素激动剂（GnRH-a）方案周期。在荟萃分析中，我们检索了PubMed、Embase、Cochrane图书馆、科学网、中国生物医学文献数据库、中国知网、万方和维普数据库以及临床试验注册网站。根据基线特征是否平衡，对胚胎和妊娠结局进行汇总分析或叙述性分析。
在我们的回顾性研究中，与GnRH激动剂方案相比，接受PPOS和GnRH拮抗剂方案的患者年龄更大，窦卵泡数量、抗苗勒管激素（AMH）水平、刺激持续时间、促性腺激素（Gn）剂量以及获取的卵母细胞和整倍体囊胚数量均显著减少。回归分析表明，卵巢刺激方案与整倍体囊胚数量或每次活检的整倍体囊胚率无关。三组之间每次胚胎移植的生化妊娠率、临床妊娠率、早产率、活产率或流产率均无显著差异。荟萃分析纳入了七项研究的数据。PPOS方案与GnRH拮抗剂方案在刺激持续时间、Gn剂量、获取的卵母细胞数量、整倍体囊胚数量、整倍体囊胚率、临床妊娠率或活产率方面无显著差异，但PPOS方案的流产率显著降低。
目前的研究结果表明，PPOS方案在胚胎整倍体状态或妊娠结局方面与其他卵巢刺激方案相当，可能是PGT-A周期中一个有吸引力的选择，这需要在更多设计良好的随机对照试验和长期随访中得到验证。
