Wu Ning, Li Xin, Zeng Cheng, Shang Jing, Yang Xiuli, Xue Qing
Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, 134, P. R. China.
J Ovarian Res. 2025 Mar 7;18(1):47. doi: 10.1186/s13048-025-01613-6.
Poor ovarian response (POR) is a challenging condition in assisted reproduction technology. Oral contraceptives (OCs) are commonly used to suppress gonadotropin hormone release in POR patients to synchronize the development of antral follicles before ovarian stimulation. Nevertheless, the question of whether such approach confers advantageous outcomes has elicited inconclusive results in previous studies. Therefore, the objective of this study was to investigate the effect of OCs pretreatment in low prognosis patients stratified by Patient-Oriented Strategies Encompassing Individualized Oocyte Number (POSEIDON) criteria.
This retrospective cohort study included 2,222 patients undergoing their first IVF or ICSI cycle from January 2012 to April 2022. After propensity score matching, 369 patients were in the OC pretreatment group and 879 in the control group. Patients were divided into four subgroups based on the POSEIDON criteria. Comparisons of ovarian response and clinical outcomes were conducted, and multivariable logistic regression was used to assess the association between OCs pretreatment and live birth, clinical pregnancy, and pregnancy loss rates.
Patients in POSEIDON group 1 who received OCs pretreatment exhibited a significant reduction in the dose and duration of gonadotropin administration, along with an increase in the number of oocytes retrieved, 2 pronuclei, available embryos, and good quality embryos, indicating an improvement in their ovarian response to exogenous gonadotropins. Additionally, the live birth rate (P = 0.030) and clinical pregnancy rate (P = 0.012) were significantly higher in the OCs pretreatment group. Multivariate logistic regression analysis demonstrated a positive association between OCs pretreatment and live birth rate (P = 0.008) and clinical pregnancy rate (P = 0.008). However, in POSEIDON group 2 to group 4, there were no significant differences in ovarian response or clinical outcomes between the OCs pretreatment group and the control group.
Administering OCs as pretreatment prior to ovarian stimulation using gonadotrophin releasing hormone antagonist protocol appears to be a more favorable approach than waiting for natural menses in low prognosis patients belonging to POSEIDON group 1.
卵巢反应不良（POR）是辅助生殖技术中一个具有挑战性的情况。口服避孕药（OCs）常用于抑制POR患者的促性腺激素释放，以便在卵巢刺激前同步窦卵泡的发育。然而，这种方法是否能带来有利结果的问题在以往研究中得出了不确定的结果。因此，本研究的目的是调查根据以患者为导向的策略制定的个体化卵母细胞数量标准（POSEIDON）对低预后患者进行OCs预处理的效果。
这项回顾性队列研究纳入了2012年1月至2022年4月期间接受首次体外受精（IVF）或卵胞浆内单精子注射（ICSI）周期的2222名患者。经过倾向得分匹配后，OCs预处理组有369名患者，对照组有879名患者。根据POSEIDON标准将患者分为四个亚组。对卵巢反应和临床结局进行了比较，并使用多变量逻辑回归来评估OCs预处理与活产、临床妊娠和流产率之间的关联。
接受OCs预处理的POSEIDON 1组患者促性腺激素给药的剂量和持续时间显著减少，同时回收的卵母细胞数量、2原核、可用胚胎和优质胚胎数量增加，表明其对促性腺激素的卵巢反应有所改善。此外，OCs预处理组的活产率（P = 0.030）和临床妊娠率（P = 0.012）显著更高。多变量逻辑回归分析表明，OCs预处理与活产率（P = 0.008）和临床妊娠率（P = 0.008）之间存在正相关。然而，在POSEIDON 2组至第IV组中，OCs预处理组和对照组之间在卵巢反应或临床结局方面没有显著差异。
对于属于POSEIDON 1组的低预后患者，在使用促性腺激素释放激素拮抗剂方案进行卵巢刺激之前给予OCs作为预处理似乎比等待自然月经更为有利。
