PDF(Pubmed)
Abstract：
To evaluate the outcomes of a long GnRH agonist protocol with corifollitropin alfa followed by hMG in low responders.
Retrospective cohort study. Patients with a suboptimal previous ovarian response (<9 oocytes) and a normal ovarian reserve (Poseidon groups 1 and 2) were classified in 1) Group 1 (n=88), submitted to a second cycle with a GnRH antagonist protocol using rFSH/hMG; 2) Group 2 (n=66), submitted to a long GnRH agonist protocol with corifollitropin alfa followed by hMG (named as simplified long protocol). Clinical outcomes were compared between groups and between the first/second cycle of each group.
Clinical outcomes were similar between groups. There were no differences in the number of oocytes [7(5-11.75) versus 7(5-10), p=0.802], clinical pregnancy (19.3% versus 18.2%, p=0.858) and live birth rates (18.2% versus 15.2%, p=0.619). However, baseline characteristics were different, decoding a poor prognosis among women in group 2. Both groups (1 and 2) had significantly higher number of oocytes, pregnancy, and live birth rates in the second cycle. In group 2, there was a higher rate of embryo transfer (56.1% versus 27.3%, p<0.001). In group 1, despite the similar rate of embryo transfer, there was a higher positive hCG (23.9% versus 8.0%, p=0.004).
Both simplified long protocol and GnRH antagonist protocol are suitable for low responders. The best second cycle clinical outcomes experienced in a population with worse prognosis (group 2) suggests that the simplified long protocol may be a better option, although prospective well-conducted studies must explore this hypothesis.
Retrospective cohort study. Patients with a suboptimal previous ovarian response (<9 oocytes) and a normal ovarian reserve (Poseidon groups 1 and 2) were classified in 1) Group 1 (n=88), submitted to a second cycle with a GnRH antagonist protocol using rFSH/hMG; 2) Group 2 (n=66), submitted to a long GnRH agonist protocol with corifollitropin alfa followed by hMG (named as simplified long protocol). Clinical outcomes were compared between groups and between the first/second cycle of each group.
Clinical outcomes were similar between groups. There were no differences in the number of oocytes [7(5-11.75) versus 7(5-10), p=0.802], clinical pregnancy (19.3% versus 18.2%, p=0.858) and live birth rates (18.2% versus 15.2%, p=0.619). However, baseline characteristics were different, decoding a poor prognosis among women in group 2. Both groups (1 and 2) had significantly higher number of oocytes, pregnancy, and live birth rates in the second cycle. In group 2, there was a higher rate of embryo transfer (56.1% versus 27.3%, p<0.001). In group 1, despite the similar rate of embryo transfer, there was a higher positive hCG (23.9% versus 8.0%, p=0.004).
Both simplified long protocol and GnRH antagonist protocol are suitable for low responders. The best second cycle clinical outcomes experienced in a population with worse prognosis (group 2) suggests that the simplified long protocol may be a better option, although prospective well-conducted studies must explore this hypothesis.
摘要：
目的：评估在低反应者中，采用Corifollitropinalfa和hMG的长GnRH激动剂方案的结果。
方法：回顾性队列研究。先前卵巢反应次优（<9个卵母细胞）和卵巢储备正常（波塞冬第1组和第2组）的患者分为1组）第1组（n=88），接受使用rFSH/hMG的GnRH拮抗剂方案的第二个周期;2)第2组(n=66),提交了一个长期的GnRH激动剂方案，该方案使用了corifollitropinalfa，然后是hMG（称为简化的长期方案）。比较各组之间以及每组第一/第二周期之间的临床结果。
结果：组间的临床结果相似。卵母细胞数量[7（5-11.75）与7（5-10）没有差异，p=0.802],临床妊娠（19.3%对18.2%，p=0.858)和活产率(18.2%对15.2%，p=0.619)。然而,基线特征不同，解码组2中女性的不良预后。两组（1和2）的卵母细胞数量均显着增加，怀孕,第二个周期的活产率。在第2组中，胚胎移植率较高（56.1％对27.3％，p<0.001)。在第1组中，尽管胚胎移植率相似，hCG阳性较高(23.9%对8.0%，p=0.004)。
结论：简化的长方案和GnRH拮抗剂方案都适用于低反应者。在预后较差的人群（第2组）中经历的最佳第二周期临床结果表明，简化的长方案可能是更好的选择。尽管进行良好的前瞻性研究必须探索这一假设。
方法：回顾性队列研究。先前卵巢反应次优（<9个卵母细胞）和卵巢储备正常（波塞冬第1组和第2组）的患者分为1组）第1组（n=88），接受使用rFSH/hMG的GnRH拮抗剂方案的第二个周期;2)第2组(n=66),提交了一个长期的GnRH激动剂方案，该方案使用了corifollitropinalfa，然后是hMG（称为简化的长期方案）。比较各组之间以及每组第一/第二周期之间的临床结果。
结果：组间的临床结果相似。卵母细胞数量[7（5-11.75）与7（5-10）没有差异，p=0.802],临床妊娠（19.3%对18.2%，p=0.858)和活产率(18.2%对15.2%，p=0.619)。然而,基线特征不同，解码组2中女性的不良预后。两组（1和2）的卵母细胞数量均显着增加，怀孕,第二个周期的活产率。在第2组中，胚胎移植率较高（56.1％对27.3％，p<0.001)。在第1组中，尽管胚胎移植率相似，hCG阳性较高(23.9%对8.0%，p=0.004)。
结论：简化的长方案和GnRH拮抗剂方案都适用于低反应者。在预后较差的人群（第2组）中经历的最佳第二周期临床结果表明，简化的长方案可能是更好的选择。尽管进行良好的前瞻性研究必须探索这一假设。
