Clinical Study of Different Ovulation Induction Schemes in the Treatment of Patients with Expected Poor Ovarian Response

doi:10.12280/gjszjk.20210346

Abstract

Abstract:

Objective: To compare the clinical outcomes of antagonist, microstimulation and progestin-primed ovarian stimulation (PPOS) protocols in the patients with expected poor ovarian response (POR). Methods: The expected PORs who underwent in vitro fertilization (IVF)/intra cytoplasmic sperm injection (ICSI) treatment in Maternal and Child Health Hospital Affiliated to Anhui Medical University from January 2016 to December 2020 were selected and divided into 3 groups: antagonist group (group A, 161 cycles), microstimulation group (group B, 300 cycles) and PPOS group (group C, 153 cycles). The ovulation induction outcomes of the three groups were analyzed. Due to the influence on endometrial receptivity in group C and the few fresh embryo transfer cycles in group A and B, only the clinical outcomes of the frozen-thawed embryo transfer (FET) cycles (120 cycles in group A, 114 cycles in group B, 65 cycles in group C) were collected. Results: The amount of gonadotrophin (Gn) in group A was higher than that in group B or group C, the number of Gn days was shorter in the group B than group A (both P<0.05). The number of oocytes retrieved in group A was more than group B or group C, and this number in group B was in the middle (P<0.05). The number of mature oocytes (MⅡ) in group A was more than that in group B or group C (P<0.05). The cycle cancellation rate in group C was higher than that in group A or group B (P<0.05). However, there were no significant differences in the number of available embryos, the number of high-quality embryos, fertilization rate, cleavage rate, implantation rate and clinical pregnancy rate of FET among the three groups (all P>0.05). Conclusions: Compared with the antagonist program, the microstimulation program has less Gn amount and shorter time. Compared with the PPOS program, the microstimulation program has a lower cycle cancellation rate. The clinical outcomes of the FET cycle in the three programs were similar. The microstimulation program is more suitable for those patients with expected POR.

Key words: Ovulation induction, Fertilization in vitro, Sperm injections,intracytoplasmic, Poor ovarian response, Minimal stimulation protocol, Antagonist protocol, Progestin-primed ovarian stimulation protocol

LI Wan-qing, HONG Ming-yun, TANG Zhi-xia. Clinical Study of Different Ovulation Induction Schemes in the Treatment of Patients with Expected Poor Ovarian Response[J]. Journal of International Reproductive Health/Family Planning, 2022, 41(1): 1-5.

Figures/Tables 4

References 23

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组别	周期	年龄（岁）	不孕时间（年）	BMI（kg/m²）	AMH（ng/mL）	基础FSH（U/L）
A组	161	37.61±5.73	3.0（1.0,6.0）	22.84±2.82	0.58±0.30	11.69±6.47
B组	300	38.55±5.46	3.0（1.0,7.0）	22.98±2.76	0.54±0.31	11.96±6.62
C组	153	37.62±6.07	3.0（1.0,7.5）	22.51±2.74	0.51±0.30	13.02±6.47
F或χ²		2.087	0.019	1.435	1.736	1.885
P		0.125	0.991	0.239	0.177	0.153

组别	周期	年龄（岁）	不孕时间（年）	BMI（kg/m²）	AMH（ng/mL）	基础FSH（U/L）
A组	161	37.61±5.73	3.0（1.0,6.0）	22.84±2.82	0.58±0.30	11.69±6.47
B组	300	38.55±5.46	3.0（1.0,7.0）	22.98±2.76	0.54±0.31	11.96±6.62
C组	153	37.62±6.07	3.0（1.0,7.5）	22.51±2.74	0.51±0.30	13.02±6.47
F或χ²		2.087	0.019	1.435	1.736	1.885
P		0.125	0.991	0.239	0.177	0.153

组别	周期	Gn用量（IU）	Gn时间（d）	获卵数（个）	MⅡ卵数（个）	可用胚胎数（个）	优质胚胎数（个）	受精率	卵裂率	周期取消率
A组	161	2 238.66±799.97	7.94±2.28	2.41±1.36	2（1,2）	1（1,2）	1（0,1）	77.90（289/371）	92.73（268/289）	21.74（35/161）
B组	300	1 240.58±537.71*	7.21±2.45*	1.80±1.04*	1（0,2）*	1（1,2）	1（0,1）	75.76（400/528）	94.00（376/400）	22.67（68/300）
C组	153	1 359.35±685.34*	7.67±3.07	1.53±1.16*^△	1（0,2）*	1（1,1）	1（0,1）	77.62（163/210）	92.02（150/163）	32.68（50/153）*^△
F或 χ²		129.647	4.672	22.794	32.859	3.333	1.028	0.652	0.858	6.609
P		0.000	0.010	0.000	<0.001	0.189	0.598	0.722	0.651	0.037

组别	周期	Gn用量（IU）	Gn时间（d）	获卵数（个）	MⅡ卵数（个）	可用胚胎数（个）	优质胚胎数（个）	受精率	卵裂率	周期取消率
A组	161	2 238.66±799.97	7.94±2.28	2.41±1.36	2（1,2）	1（1,2）	1（0,1）	77.90（289/371）	92.73（268/289）	21.74（35/161）
B组	300	1 240.58±537.71*	7.21±2.45*	1.80±1.04*	1（0,2）*	1（1,2）	1（0,1）	75.76（400/528）	94.00（376/400）	22.67（68/300）
C组	153	1 359.35±685.34*	7.67±3.07	1.53±1.16*^△	1（0,2）*	1（1,1）	1（0,1）	77.62（163/210）	92.02（150/163）	32.68（50/153）*^△
F或 χ²		129.647	4.672	22.794	32.859	3.333	1.028	0.652	0.858	6.609
P		0.000	0.010	0.000	<0.001	0.189	0.598	0.722	0.651	0.037

组别	周期	年龄（岁）	BMI （kg/m²）	子宫内膜厚度（mm）	移植胚胎数（个）	优质胚胎移植
A组	120	37.93±5.38	23.32±3.56	10.12±2.14	1.43±0.51	95（79.17）
B组	114	38.79±5.65	23.25±2.61	9.94±2.02	1.39±0.51	91（79.82）
C组	65	38.09±5.70	22.73±2.71	9.85±2.42	1.48±0.53	49（75.38）
F或 χ²		0.750	0.860	0.371	0.650	0.524
P		0.473	0.424	0.690	0.523	0.770