Wu Hsien-Ming, Weng Cindy Hsuan, Sung Yen-Ju, Hsu Le-Tien, Huang Shang-Yu, Chang Chia-Lin, Huang Hong-Yuan, Soong Yung-Kuei, Chen Liang-Hsuan
Department of Obstetrics and Gynecology, LinKou Medical Center, Chang Gung Memorial Hospital, No. 5, Fusing St., Gueishan Dist, Taoyuan City, 333, Taiwan.
Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
J Ovarian Res. 2025 Aug 12;18(1):181. doi: 10.1186/s13048-025-01768-2.
Vitrification improves post-thawed embryo recovery and enables new strategies for in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI). Due to its convenience and efficacy, progestin-primed ovarian stimulation (PPOS) gets more attention in daily practice. However, concerns about the impact of PPOS on oocyte and embryo quality still exist. We aimed to compare the embryological and pregnancy outcomes between PPOS and gonadotropin-releasing hormone (GnRH) antagonist protocol in IVF/ICSI cases.
This was a retrospective cohort study of 545 women undergoing IVF/ICSI cycles from July 2017 to December 2018. The patients were allocated into two groups: the PPOS and GnRH antagonist group, based on 1:1 propensity score matching. In both groups, all viable embryos were cryopreserved for later transfer. The primary endpoint was the prevalence of smooth endoplasmic reticulum aggregates (SERa) in oocytes. Secondary outcomes included the cycle characteristics and pregnancy outcomes.
Ovarian stimulation duration and serum estradiol level on trigger day were significantly higher in the PPOS group compared to the GnRH antagonist group. The prevalence of SERa + cycles was 9.4% in our cohort (13.0% and 12.2% in the PPOS and GnRH antagonist groups, respectively, p = 0.221). There were more frozen embryos (5.3 ± 4.5 vs. 4.8 ± 4.0, p = 0.378) in the PPOS group than in the GnRH group, particularly for the subgroup of low responders (1.6 ± 1.2 vs. 1.2 ± 1.0, p = 0.043). No significant differences were observed between the groups regarding clinical pregnancy rate, miscarriage, live birth rate, and cumulative live birth rate in the following two years after oocyte retrieval.
Our findings suggest that the PPOS protocol provides clinical benefits and safety with comparable oocyte quality and pregnancy outcomes to the GnRH antagonist protocol.
玻璃化冷冻技术可提高解冻后胚胎的复苏率，并为体外受精/卵胞浆内单精子注射（IVF/ICSI）带来新策略。由于其便利性和有效性，孕激素预处理的卵巢刺激方案（PPOS）在日常实践中受到更多关注。然而，关于PPOS对卵母细胞和胚胎质量的影响仍存在担忧。我们旨在比较IVF/ICSI病例中PPOS方案与促性腺激素释放激素（GnRH）拮抗剂方案的胚胎学和妊娠结局。
这是一项对2017年7月至2018年12月期间接受IVF/ICSI周期治疗的545名女性进行的回顾性队列研究。根据1:1倾向评分匹配，将患者分为两组：PPOS组和GnRH拮抗剂组。两组中，所有存活胚胎均进行冷冻保存以备后续移植。主要终点是卵母细胞中滑面内质网聚集体（SERa）的发生率。次要结局包括周期特征和妊娠结局。
与GnRH拮抗剂组相比，PPOS组的卵巢刺激持续时间和扳机日血清雌二醇水平显著更高。我们队列中SERa+周期的发生率为9.4%（PPOS组和GnRH拮抗剂组分别为13.0%和12.2%，p = 0.221）。PPOS组的冷冻胚胎数量（5.3±4.5 vs. 4.8±4.0，p = 0.378）多于GnRH组，尤其是低反应者亚组（1.6±1.2 vs. 1.2±1.0，p = 0.043）。在卵母细胞取出后的两年内，两组在临床妊娠率、流产率、活产率和累积活产率方面未观察到显著差异。
我们的研究结果表明，PPOS方案具有临床益处和安全性，其卵母细胞质量和妊娠结局与GnRH拮抗剂方案相当。
