Effects of different pretreatments prior to gonadotropin stimulation on the clinical outcomes of POSEIDON expected poor ovarian response patients
10.3760/cma.j.cn101441-20190514-00193
- VernacularTitle:启动促性腺激素前不同预处理对POSEIDON预期卵巢低反应患者临床结局的影响
- Author:
Xiaoguo DU
1
;
Rui YANG
1
;
Xinna CHEN
1
;
Rong LI
1
;
Ying WANG
1
;
Hongzhen LI
1
Author Information
1. 北京大学第三医院妇产科生殖医学中心 100191
- Publication Type:Journal Article
- Keywords:
Gonadotropin-releasing hormone;
Ultrashort gonadotropin-releasing hormone agonist;
Gonadotropin-releasing hormone antagonist;
Pretreatment;
Poor ovarian r
- From:
Chinese Journal of Reproduction and Contraception
2020;40(7):540-546
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the effect of different pretreatments on the in vitrofertilization (IVF) outcome of expected poor ovarian response (POR) patients according to POSEIDON criteria, and explore the appropriate treatment for POR patients. Methods:A retrospective analysis of the clinical data of 364 cycles of expected POR patients who received in vitro fertilization-embryo transfer (IVF-ET) in the Center of Reproductive Medicine, Department of Obstetrics & Gynecology， Peking University Third Hospital from January 2016 to May 2018 was performed. According to the pretreatment prior to gonadotropin (Gn) stimulation, the cycles were divided into oral contraceptive (OCP) group (group A, n=167), estradiol valerate group (group B, n=56) and no pretreatment group (group C, n=141). The clinical data,ovarian stimulation indexes, laboratory status and the clinical pregnancy rate were compared among the three groups. Results:The age of patients in group A [(34.8±4.9) years] was significantly younger than that of group B [(38.0±4.9) years] and group C [(37.9±4.7) years] ( P<0.001). The body mass index (BMI) of group B [(21.9±3.1) kg/m 2] was significantly lower than that of group A [(23.5±3.6) kg/m 2] and group C [(23.2±3.1) kg/m 2] ( P=0.014). There were significant differences in the antral follicle count (AFC) among group A (2.4±2.0), group B (4.1±1.9) and group C (3.5±2.0) ( P<0.001). The proportion of anovulation in group A (32.9%) was significantly higher than that in group B (10.7%) and group C (11.3%) ( P<0.001). The number of IVF cycles in group C (3.0±1.7) was higher than that in group A (2.5±1.5)（ P=0.017）. There was no significant difference in type of infertility, duration of infertility, basal follicle-stimulating hormone (FSH) and anti-Müllerian hormone (AMH) among the three groups ( P>0.05). The endometrial thickness on the day of human chorionic gonadotropin (hCG) injection in group A [(9.4±1.9) mm] was thinner than that in group B [(10.6±1.5) mm] and group C [(10.1±2.0) mm] ( P<0.001). The fertilization rate of group A (77.1%) and group B (77.6%) was significantly higher than that of group C (71.3%) ( P=0.041). There were no significant differences in Gn used dosage, duration of Gn stimulation, number of eggs obtained, intracytoplasmic sperm injection (ICSI) proportion, cleavage rate, number of embryos available for transfer and number of high-quality embryos among the three groups ( P>0.05). The implantation rate and the clinical pregnancy rate in group A (26.2%, 36.1%) and group B (26.8%, 42.0%) were significantly higher than those in group C (14.5%, 21.2%) ( P=0.014). There were no significant differences in embryo transfer cycle, number of embryos transferred, proportion of blastocyst transfer cycle, abortion rate and cycle cancellation rate among the three groups ( P>0.05). Conclusion:Pretreatment with OCP or estradiol valerate in luteal phase prior to Gn stimulation can improve the clinical outcomes of patients with expected POR. OCP pretreatment is suitable for POR patients with ovulation disorder, while estradiol pretreatment in luteal phase is suitable for POR patients with ovulation.
