Souza Marcelo Marinho de, Souza Maria do Carmo Borges de, Antunes Roberto de Azevedo, Barbeitas Ana Luíza, Raupp Verônica de Almeida, Souza Ana Luísa Bruno Marinho de, Silva Layna Almeida Barbosa da, Mancebo Ana Cristina Allemand, Sequeira Flávia Fernandes
Fertipraxis - Human Reproduction Center. Barra da Tijuca, Rio de Janeiro - RJ, Brazil.
Federal University of Rio de Janeiro - Gynecology Departament of the Clementino Fraga Filho Universitary Hospital. Cidade Universitária da Universidade Federal do Rio de Janeiro, Rio de Janeiro - RJ, Brazil.
JBRA Assist Reprod. 2025 Mar 13;29(2):317-22. doi: 10.5935/1518-0557.20250003.
To evaluate Dydrogesterone's effectiveness in PPOS protocols for IVF/ICSI or oocyte cryopreservation, focusing on LH surge suppression and metaphase II oocyte yield.
A retrospective, comparative, single-center study of 550 IVF/ICSI and 186 oocyte cryopreservation cycles was conducted from January 2018 to December 2020. Exclusion criteria included endometriosis, previous ovarian surgery, ovarian insufficiency, and abnormal FSH/LH levels. Patients received either Follitropin delta (Rekovelle®) or Menotropin (Menopur®). LH surge blockade was achieved with GnRH antagonist (Cetrotide®) or DYG (Duphaston®). Primary outcome was incidence of premature LH surge; secondary outcomes included follicle size on hCG day, metaphase II oocytes, cancelled cycles, and OHSS. ANCOVA analyses were used, with partial squared Eta as the effect size index.
Premature LH peak with early follicular rupture occurred in 2 cases in Group 1 (Ant) and 3 cases in Group 2 (DYG), without statistical significance. LH levels on trigger day showed no difference (Ant: 2.63 - SD 1.15 vs. DYG: 2.47 - SD 1.22). Oocyte maturation at metaphase II (MII) stage was similar (6.28 - SD 4.72 vs. 6.71 - SD 4.53). Follicle size differed: fewer follicles ≥ 18 mm in Ant group (3.33 - SD 2.06 vs. 4.19 - SD 2.53; p=0.001), but more 15-17 mm follicles (p=0.024). No moderate to severe OHSS occurred in patients with AMH >3 ng/mL.
DYG is an eligible tool for IVF/ICSI cycles intended to freeze-all and oocyte preservation, embryo banking, and preventing OHSS in patients with high AMH levels.
评估地屈孕酮在用于体外受精/卵胞浆内单精子注射（IVF/ICSI）或卵母细胞冷冻保存的PPOS方案中的有效性，重点关注促黄体生成素（LH）峰抑制和中期II卵母细胞产量。
对2018年1月至2020年12月期间的550个IVF/ICSI周期和186个卵母细胞冷冻保存周期进行了一项回顾性、比较性、单中心研究。排除标准包括子宫内膜异位症、既往卵巢手术史、卵巢功能不全以及促卵泡生成素（FSH）/LH水平异常。患者接受了注射用重组促卵泡素δ（Rekovelle®）或尿促性素（Menopur®）。使用促性腺激素释放激素（GnRH）拮抗剂（Cetrotide®）或地屈孕酮（Duphaston®）实现LH峰阻断。主要结局是过早LH峰的发生率；次要结局包括注射人绒毛膜促性腺激素（hCG）当天的卵泡大小、中期II卵母细胞、取消的周期以及卵巢过度刺激综合征（OHSS）。采用协方差分析，以偏平方η作为效应量指标。
第1组（拮抗剂组）有2例发生伴有早期卵泡破裂的过早LH峰，第2组（地屈孕酮组）有3例，无统计学意义。扳机日的LH水平无差异（拮抗剂组：2.63 - 标准差1.15 vs. 地屈孕酮组：2.47 - 标准差1.22）。中期II（MII）期的卵母细胞成熟情况相似（6.28 - 标准差4.72 vs. 6.71 - 标准差4.53）。卵泡大小存在差异：拮抗剂组≥18 mm的卵泡较少（3.33 - 标准差2.06 vs. 4.19 - 标准差2.53；p = 0.001），但15 - 17 mm的卵泡较多（p = 0.024）AMH>3 ng/mL的患者未发生中度至重度OHSS。
地屈孕酮是用于旨在全冷冻和卵母细胞保存、胚胎库建立以及预防高AMH水平患者发生OHSS的IVF/ICSI周期的合适工具。
