非洲的体外受精：预期正常反应者在接受体外受精/卵胞浆内单精子注射时温和与传统拮抗剂卵巢刺激方案的比较：一项来自埃塞俄比亚的队列研究
In Vitro Fertilization in Africa: Mild Versus Conventional Antagonist Ovarian Stimulation Protocols in Expected Normal Responders Undergoing IVF/ICSI: A Cohort Study From Ethiopia.
作者信息
Kedir Mekia, Negash Mustafa, Teshome Abel, Sium Abraham Fessehaye
机构信息
Department of Obstetrics and Gynecology St. Paul's Hospital Millennium Medical College (SPHMMC) Addis Ababa Ethiopia.
出版信息
Public Health Chall. 2025 Jul 28;4(3):e70089. doi: 10.1002/puh2.70089. eCollection 2025 Sep.
BACKGROUND
Though infertility remains a global public health problem, it stands as a unique challenge in Sub-Saharan Africa, with either no or limited in vitro fertilization (IVF) service in most countries located in it. This study aimed to compare the efficacy of mild stimulation with conventional GnRH antagonist ovarian stimulation in patients with expected normal responders at a public IVF center in Ethiopia.
METHODS
A retrospective cohort study was conducted at Center for Fertility and Reproductive Medicine in Ethiopia. The primary outcomes were biochemical pregnancy rate, clinical pregnancy rate, and mature (M2) oocyte retrieval rate. Data were collected retrospectively by reviewing medical records of patients. SPSS version 26 was used to analyze the data. Mann-Whitney test and chi-squared/exact were performed as appropriate. value less than 0.05 was used to present the results significance.
RESULTS
Five hundred infertile women (age ≤39) undergoing their first IVF cycle. A total of 150 women exposed to mild stimulation group and 350 women exposed to conventional or antagonist IVF-group). The biochemical pregnancy was higher in MS-IVF, which is 35.3% and 28.6% in conventional (antagonist) IVF group, value = 0.04. Clinical pregnancy rate (35.4% in the MS-IVF vs. 25.8% in the antagonist arm, value = 0.2) and early abortion (8.8% in the MS-IVF group vs. 3.7% in the antagonist group, value = 0.3) were not statistically different between the groups. There was no difference in the rate of ovarian hyperstimulation syndrome (OHSS) between the groups. The total dose of gonadotrophin used for stimulation was lower in MS group (1274 ± 546 in MS group vs. 2776 ± 719 in the antagonist group, < 0.001).
CONCLUSIONS
Compared to conventional antagonist IVF, MS-IVF has a higher biochemical pregnancy and lower risk of multiple pregnancy with comparative rates of clinical pregnancy, OHSS, and mature oocyte (M2).
背景
尽管不孕症仍然是一个全球性的公共卫生问题，但在撒哈拉以南非洲地区，它却是一项独特的挑战，该地区大多数国家要么没有体外受精（IVF）服务，要么此类服务有限。本研究旨在比较在埃塞俄比亚一家公立IVF中心，温和刺激方案与传统促性腺激素释放激素（GnRH）拮抗剂卵巢刺激方案对预期反应正常的患者的疗效。
方法
在埃塞俄比亚生育与生殖医学中心开展了一项回顾性队列研究。主要结局指标为生化妊娠率、临床妊娠率和成熟（M2）卵母细胞获取率。通过查阅患者病历回顾性收集数据。使用SPSS 26版软件分析数据。根据情况进行曼-惠特尼检验和卡方检验/确切概率法检验。P值小于0.05表示结果具有显著性。
结果
500名年龄≤39岁的不孕女性接受首次IVF周期治疗。共有150名女性接受温和刺激方案组，350名女性接受传统或拮抗剂IVF方案组。温和刺激IVF组的生化妊娠率更高，分别为35.3%，而传统（拮抗剂）IVF组为28.6%，P值 = 0.04。两组间临床妊娠率（温和刺激IVF组为35.4%，拮抗剂组为25.8%，P值 = 0.2）和早期流产率（温和刺激IVF组为8.8%，拮抗剂组为3.7%，P值 = 0.3）无统计学差异。两组间卵巢过度刺激综合征（OHSS）发生率无差异。温和刺激组用于刺激的促性腺激素总剂量较低（温和刺激组为1274±546，拮抗剂组为2776±719，P<0.001）。
结论
与传统拮抗剂IVF相比，温和刺激IVF的生化妊娠率更高，多胎妊娠风险更低，临床妊娠率、OHSS发生率和成熟卵母细胞（M2）率相当。
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