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.
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。