Boynukalin Fazilet Kubra, Tohma Yusuf Aytaç, Gultomruk Meral, Yarkiner Zalihe, Akkaya Ceren Melisa, Ozkavukcu Sinan, Bahceci Mustafa, Bozdağ Gürkan
Department of Infertility Clinic, Bahceci Fulya IVF Center, Istanbul, Türkiye.
Department of Obstetrics and Gynecology, Uskudar University, Istanbul, Türkiye.
Front Endocrinol (Lausanne). 2025 Jul 8;16:1492293. doi: 10.3389/fendo.2025.1492293. eCollection 2025.
Do embryo parameters and live birth rates differ between patients with endometrioma undergoing a freeze-all strategy using either GnRH antagonists or progestin-primed ovarian stimulation (PPOS)?
This retrospective cohort study was conducted at Bahceci Health Group from January 2021 to January 2023. Inclusion criteria were females aged 20-40 with confirmed endometriosis, using either GnRH antagonists or PPOS ovarian stimulation, and opting for freezing all embryos without fresh embryo transfer (ET). A total of 543 patients were analyzed, with the primary outcome being usable embryos at cleavage stage and secondary outcomes including distribution of embryo quality, clinical pregnancy, and live birth rate.
For the GnRH antagonist arm, the median (25th-75th percentiles) total gonadotropin dose required during stimulation was significantly higher (2725 [2100-3587.5] vs. 2400 [2050-3075] IU, p = 0.001) and duration was longer (11 [10-12] vs. 10 [9-11] days, p = 0.01), although number of mature oocytes and maturation and fertilization rates were similar in both arms. However, the linear regression analysis revealed that the number of usable day-three embryos was higher with the PPOS protocol than with the GnRH antagonist protocol (OR: 0.890, CI 95%: 0.226 - 1.554, p= 0.009). Particularly in patients that had undergone FET, the respective live birth rates were 50.0% and 54.6% in GnRH antagonist and PPOS arms, respectively, without any statistical significance (p= 0.365).
In patients with endometrioma, the PPOS protocol over GnRH antagonists might potentially enhance the quantity of usable cleavage-stage embryos while showing no significant impact on the number of collected oocytes.
在采用促性腺激素释放激素（GnRH）拮抗剂或孕激素预处理卵巢刺激（PPOS）的全胚胎冷冻策略的子宫内膜异位症患者中，胚胎参数和活产率是否存在差异？
本回顾性队列研究于2021年1月至2023年1月在巴赫切西健康集团进行。纳入标准为年龄在20 - 40岁、确诊患有子宫内膜异位症、使用GnRH拮抗剂或PPOS卵巢刺激且选择冷冻所有胚胎而不进行新鲜胚胎移植（ET）的女性。共分析了543例患者，主要结局为卵裂期可用胚胎，次要结局包括胚胎质量分布、临床妊娠和活产率。
对于GnRH拮抗剂组，刺激期间所需的促性腺激素总剂量中位数（第25 - 75百分位数）显著更高（2725 [2100 - 3587.5] 国际单位 vs. 2400 [2050 - 3075] 国际单位，p = 0.001）且持续时间更长（11 [10 - 12] 天 vs. 10 [9 - 11] 天，p = 0.01），尽管两组的成熟卵母细胞数量以及成熟率和受精率相似。然而，线性回归分析显示，PPOS方案的第三天可用胚胎数量高于GnRH拮抗剂方案（比值比：0.890，95%置信区间：0.226 - 1.554，p = 0.009）。特别是在接受冻融胚胎移植（FET）的患者中，GnRH拮抗剂组和PPOS组的活产率分别为50.0%和54.6%，无统计学意义（p = 0.365）。
对于患有子宫内膜异位症的患者，与GnRH拮抗剂相比，PPOS方案可能会增加卵裂期可用胚胎的数量，而对采集的卵母细胞数量无显著影响。
