PDF(Pubmed)
Abstract：
OBJECTIVE: An impact of different gonadotrophins selection for ovarian stimulation (OS) on oocyte competence has yet to be defined. In this study, we asked whether an association exists between OS protocol and euploid blastocyst rate (EBR) per metaphase-II (MII) oocytes.
METHODS: Cycles of first preimplantation genetic testing for aneuploidies conducted by women ≥ 35 years old with their own metaphase-II oocytes inseminated in the absence of severe male factor (years 2014-2018) were clustered based on whether recombinant FSH (rec-FSH) or human menopausal gonadotrophin (HMG) was used for OS, then matched for the number of fresh inseminated eggs. Four groups were outlined: rec-FSH (N = 57), rec-FSH plus rec-LH (N = 55), rec-FSH plus HMG (N = 112), and HMG-only (N = 127). Intracytoplasmic sperm injection, continuous blastocyst culture, comprehensive chromosome testing to assess full-chromosome non-mosaic aneuploidies and vitrified-warmed euploid single embryo transfers (SETs) were performed. The primary outcome was the EBR per cohort of MII oocytes. The secondary outcome was the live birth rate (LBR) per first SETs.
RESULTS: Rec-FSH protocol was shorter and characterized by lower total gonadotrophin (Gn) dose. The linear regression model adjusted for maternal age showed no association between the Gn adopted for OS and EBR per cohort of MII oocytes. Similarly, no association was reported with the LBR per first SETs, even when adjusting for blastocyst quality and day of full blastulation.
CONCLUSIONS: In view of enhanced personalization in OS, clinicians shall focus on different endpoints or quantitative effects related to Gn action towards follicle recruitment, development, and atresia. Here, LH and/or hCG was administered exclusively to women with expected sub/poor response; therefore, we cannot exclude that specific Gn formulations may impact patient prognosis in other populations.
METHODS: Cycles of first preimplantation genetic testing for aneuploidies conducted by women ≥ 35 years old with their own metaphase-II oocytes inseminated in the absence of severe male factor (years 2014-2018) were clustered based on whether recombinant FSH (rec-FSH) or human menopausal gonadotrophin (HMG) was used for OS, then matched for the number of fresh inseminated eggs. Four groups were outlined: rec-FSH (N = 57), rec-FSH plus rec-LH (N = 55), rec-FSH plus HMG (N = 112), and HMG-only (N = 127). Intracytoplasmic sperm injection, continuous blastocyst culture, comprehensive chromosome testing to assess full-chromosome non-mosaic aneuploidies and vitrified-warmed euploid single embryo transfers (SETs) were performed. The primary outcome was the EBR per cohort of MII oocytes. The secondary outcome was the live birth rate (LBR) per first SETs.
RESULTS: Rec-FSH protocol was shorter and characterized by lower total gonadotrophin (Gn) dose. The linear regression model adjusted for maternal age showed no association between the Gn adopted for OS and EBR per cohort of MII oocytes. Similarly, no association was reported with the LBR per first SETs, even when adjusting for blastocyst quality and day of full blastulation.
CONCLUSIONS: In view of enhanced personalization in OS, clinicians shall focus on different endpoints or quantitative effects related to Gn action towards follicle recruitment, development, and atresia. Here, LH and/or hCG was administered exclusively to women with expected sub/poor response; therefore, we cannot exclude that specific Gn formulations may impact patient prognosis in other populations.
摘要：
目的：选择不同促性腺激素用于卵巢刺激（OS）对卵母细胞能力的影响尚未确定。在这项研究中,我们询问OS方案与每个中期II(MII)卵母细胞的整倍体囊胚率(EBR)之间是否存在关联.
方法：根据是否使用重组FSH（rec-FSH）或人类促性腺激素（HMG）对OS进行聚类，对年龄≥35岁的女性进行非整倍体的首次植入前遗传学测试进行聚类。然后匹配新鲜授精卵的数量。概述了四组：rec-FSH(N=57)，rec-FSH加rec-LH（N=55），rec-FSH加HMG(N=112)，和仅HMG(N=127)。卵胞浆内单精子注射,连续囊胚培养,进行了全面的染色体测试，以评估全染色体非镶嵌非整倍体和玻璃化加热的整倍体单胚胎移植（SET）。主要结果是每个MII卵母细胞队列的EBR。次要结果是每第一次SET的活产率（LBR）。
结果：Rec-FSH方案较短，其特征是总促性腺激素（Gn）剂量较低。根据母亲年龄调整的线性回归模型显示，每个MII卵母细胞队列中OS采用的Gn和EBR之间没有关联。同样，没有报告与LBR的第一个SET关联，即使在调整囊胚质量和完全囊胚形成天数时。
结论：鉴于操作系统中增强的个性化，临床医生应关注与Gn对卵泡募集的作用相关的不同终点或定量效应，发展,和闭锁。这里,LH和/或hCG仅用于预期反应低于/较差的女性；因此，我们不能排除特定Gn制剂可能影响其他人群的患者预后.
方法：根据是否使用重组FSH（rec-FSH）或人类促性腺激素（HMG）对OS进行聚类，对年龄≥35岁的女性进行非整倍体的首次植入前遗传学测试进行聚类。然后匹配新鲜授精卵的数量。概述了四组：rec-FSH(N=57)，rec-FSH加rec-LH（N=55），rec-FSH加HMG(N=112)，和仅HMG(N=127)。卵胞浆内单精子注射,连续囊胚培养,进行了全面的染色体测试，以评估全染色体非镶嵌非整倍体和玻璃化加热的整倍体单胚胎移植（SET）。主要结果是每个MII卵母细胞队列的EBR。次要结果是每第一次SET的活产率（LBR）。
结果：Rec-FSH方案较短，其特征是总促性腺激素（Gn）剂量较低。根据母亲年龄调整的线性回归模型显示，每个MII卵母细胞队列中OS采用的Gn和EBR之间没有关联。同样，没有报告与LBR的第一个SET关联，即使在调整囊胚质量和完全囊胚形成天数时。
结论：鉴于操作系统中增强的个性化，临床医生应关注与Gn对卵泡募集的作用相关的不同终点或定量效应，发展,和闭锁。这里,LH和/或hCG仅用于预期反应低于/较差的女性；因此，我们不能排除特定Gn制剂可能影响其他人群的患者预后.
