Abstract：
BACKGROUND: Vitrified M-II oocyte accumulation for later simultaneous insemination has been used for managing POR. Our study aimed to determine whether vitrified oocyte accumulation strategy improves live birth rate (LBR) for managing diminished ovarian reserve (DOR).
METHODS: A retrospective study included 440 women with DOR fulfilling Poseidon classification groups 3 and 4, defined as the presence of serum anti-Müllerian hormone (AMH) hormone level < 1.2 ng/ml or antral follicle count (AFC) < 5, from January 1, 2014, to December 31, 2019, in a single department. Patients underwent accumulation of vitrified oocytes (DOR-Accu) and embryo transfer (ET) or controlled ovarian stimulation (COS) using fresh oocytes (DOR-fresh) and ET. Primary outcomes were LBR per ET and cumulative LBR (CLBR) per intention to treat (ITT). Secondary outcomes were clinical pregnancy rate (CPR) and miscarriage rate (MR).
RESULTS: Two hundred eleven patients underwent simultaneous insemination of vitrified oocyte accumulation and ET in the DOR-Accu group (maternal age: 39.29 ± 4.23 y, AMH: 0.54 ± 0.35 ng/ml), and 229 patients underwent COS and ET in the DOR-fresh group (maternal age: 38.07 ± 3.77 y, AMH: 0.72 ± 0.32 ng/ml). CPR in the DOR-Accu group was similar in the DOR-fresh group (27.5% vs. 31.0%, p = 0.418). However, MR was statistically higher (41.4% vs. 14.1%, p = 0.001), while LBR per ET was statistically lower (15.2% vs. 26.2%, p < 0.001) in the DOR-Accu group. There is no difference in CLBR per ITT between groups (20.4% vs. 27.5%, p = 0.081). The secondary analysis categorized clinical outcomes into four groups regarding patients\' age. CPR, LBR per ET, and CLBR did not improve in the DOR-Accu group. In the group of 31 patients, accumulated vitrified metaphase II (M-II) oocytes reached a total number of ≥ 15, and CPR improved among the DOR-Accu group (48.4% vs. 31.0%, p = 0.054); however, higher MR (40.0% vs. 14.1%, p = 0.03) resulted in similar LBR per ET (29.0% vs. 26.2%, p = 0.738).
CONCLUSIONS: Vitrified oocyte accumulation for managing DOR did not improve LBR. Higher MR resulted in lower LBR in the DOR-Accu group. Therefore, the vitrified oocyte accumulation strategy for managing DOR is not clinically practical.
BACKGROUND: The study protocol was retrospectively registered and was approved by Institutional Review Board of Mackay Memorial Hospital (21MMHIS219e) on August 26, 2021.
METHODS: A retrospective study included 440 women with DOR fulfilling Poseidon classification groups 3 and 4, defined as the presence of serum anti-Müllerian hormone (AMH) hormone level < 1.2 ng/ml or antral follicle count (AFC) < 5, from January 1, 2014, to December 31, 2019, in a single department. Patients underwent accumulation of vitrified oocytes (DOR-Accu) and embryo transfer (ET) or controlled ovarian stimulation (COS) using fresh oocytes (DOR-fresh) and ET. Primary outcomes were LBR per ET and cumulative LBR (CLBR) per intention to treat (ITT). Secondary outcomes were clinical pregnancy rate (CPR) and miscarriage rate (MR).
RESULTS: Two hundred eleven patients underwent simultaneous insemination of vitrified oocyte accumulation and ET in the DOR-Accu group (maternal age: 39.29 ± 4.23 y, AMH: 0.54 ± 0.35 ng/ml), and 229 patients underwent COS and ET in the DOR-fresh group (maternal age: 38.07 ± 3.77 y, AMH: 0.72 ± 0.32 ng/ml). CPR in the DOR-Accu group was similar in the DOR-fresh group (27.5% vs. 31.0%, p = 0.418). However, MR was statistically higher (41.4% vs. 14.1%, p = 0.001), while LBR per ET was statistically lower (15.2% vs. 26.2%, p < 0.001) in the DOR-Accu group. There is no difference in CLBR per ITT between groups (20.4% vs. 27.5%, p = 0.081). The secondary analysis categorized clinical outcomes into four groups regarding patients\' age. CPR, LBR per ET, and CLBR did not improve in the DOR-Accu group. In the group of 31 patients, accumulated vitrified metaphase II (M-II) oocytes reached a total number of ≥ 15, and CPR improved among the DOR-Accu group (48.4% vs. 31.0%, p = 0.054); however, higher MR (40.0% vs. 14.1%, p = 0.03) resulted in similar LBR per ET (29.0% vs. 26.2%, p = 0.738).
CONCLUSIONS: Vitrified oocyte accumulation for managing DOR did not improve LBR. Higher MR resulted in lower LBR in the DOR-Accu group. Therefore, the vitrified oocyte accumulation strategy for managing DOR is not clinically practical.
BACKGROUND: The study protocol was retrospectively registered and was approved by Institutional Review Board of Mackay Memorial Hospital (21MMHIS219e) on August 26, 2021.
摘要：
背景：用于后期同时授精的玻璃化M-II卵母细胞积累已用于管理POR。我们的研究旨在确定玻璃化卵母细胞积累策略是否可以提高活产率（LBR）以管理卵巢储备功能下降（DOR）。
方法：一项回顾性研究包括从2014年1月1日至2019年12月31日，在单个部门中，有440名DOR符合波塞冬分类第3组和第4组的女性，定义为血清抗苗勒管激素（AMH）激素水平<1.2ng/ml或窦卵泡计数（AFC）<5。患者使用新鲜卵母细胞（DOR-fresh）和ET进行玻璃化卵母细胞（DOR-Accu）和胚胎移植（ET）或控制性卵巢刺激（COS）的积累。主要结果是每个ET的LBR和每个意向治疗（ITT）的累积LBR（CLBR）。次要结果是临床妊娠率（CPR）和流产率（MR）。
结果：DOR-Accu组的211例患者同时进行玻璃化卵母细胞积累和ET的授精（产妇年龄：39.29±4.23岁，AMH：0.54±0.35ng/ml），DOR新鲜组229例患者接受了COS和ET（产妇年龄：38.07±3.77岁，AMH:0.72±0.32ng/ml)。DOR-Accu组的CPR与DOR-新鲜组相似（27.5％vs.31.0%,p=0.418）。然而,MR在统计学上较高（41.4%vs.14.1%,p=0.001),而每ET的LBR在统计学上较低(15.2%vs.26.2%,P<0.001）在DOR-Accu组中。两组之间的CLBR/ITT没有差异(20.4%与27.5%,p=0.081)。次要分析根据患者年龄将临床结局分为四组。CPR,每ET的LBR,DOR-Accu组CLBR没有改善。在31名患者中，积累的玻璃化中期II（M-II）卵母细胞总数达到≥15，并且在DOR-Accu组中CPR得到改善（48.4％vs.31.0%,p=0.054)；然而，更高的MR（40.0%vs.14.1%,p=0.03）导致每个ET的LBR相似（29.0%与26.2%,p=0.738）。
结论：用于管理DOR的玻璃化卵母细胞积累并未改善LBR。较高的MR导致DOR-Accu组的LBR较低。因此,处理DOR的玻璃化卵母细胞累积策略在临床上不实用.
背景：该研究方案进行了回顾性注册，并于2021年8月26日获得了麦凯纪念医院机构审查委员会（21MMHIS219e）的批准。
方法：一项回顾性研究包括从2014年1月1日至2019年12月31日，在单个部门中，有440名DOR符合波塞冬分类第3组和第4组的女性，定义为血清抗苗勒管激素（AMH）激素水平<1.2ng/ml或窦卵泡计数（AFC）<5。患者使用新鲜卵母细胞（DOR-fresh）和ET进行玻璃化卵母细胞（DOR-Accu）和胚胎移植（ET）或控制性卵巢刺激（COS）的积累。主要结果是每个ET的LBR和每个意向治疗（ITT）的累积LBR（CLBR）。次要结果是临床妊娠率（CPR）和流产率（MR）。
结果：DOR-Accu组的211例患者同时进行玻璃化卵母细胞积累和ET的授精（产妇年龄：39.29±4.23岁，AMH：0.54±0.35ng/ml），DOR新鲜组229例患者接受了COS和ET（产妇年龄：38.07±3.77岁，AMH:0.72±0.32ng/ml)。DOR-Accu组的CPR与DOR-新鲜组相似（27.5％vs.31.0%,p=0.418）。然而,MR在统计学上较高（41.4%vs.14.1%,p=0.001),而每ET的LBR在统计学上较低(15.2%vs.26.2%,P<0.001）在DOR-Accu组中。两组之间的CLBR/ITT没有差异(20.4%与27.5%,p=0.081)。次要分析根据患者年龄将临床结局分为四组。CPR,每ET的LBR,DOR-Accu组CLBR没有改善。在31名患者中，积累的玻璃化中期II（M-II）卵母细胞总数达到≥15，并且在DOR-Accu组中CPR得到改善（48.4％vs.31.0%,p=0.054)；然而，更高的MR（40.0%vs.14.1%,p=0.03）导致每个ET的LBR相似（29.0%与26.2%,p=0.738）。
结论：用于管理DOR的玻璃化卵母细胞积累并未改善LBR。较高的MR导致DOR-Accu组的LBR较低。因此,处理DOR的玻璃化卵母细胞累积策略在临床上不实用.
背景：该研究方案进行了回顾性注册，并于2021年8月26日获得了麦凯纪念医院机构审查委员会（21MMHIS219e）的批准。
