PDF(Pubmed)
Abstract：
To explore the cycle characteristics and pregnancy outcomes of progestin-primed ovarian stimulation (PPOS) using fixed versus degressive doses of medroxyprogesterone acetate (MPA) in conjunction with letrozole (LE) in infertile women by propensity score matching (PSM) analysis.
A retrospective cohort study.
Tertiary-care academic medical center.
A total of 3173 infertile women undergoing their first in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatment within the period from January 2017 to December 2020.
A total of 1068 and 783 patients who underwent a fixed dose of MPA combined with LE and a degressive dose of MPA combined with LE protocols, respectively, were enrolled in this study. The freeze-all approach and later frozen-thawed embryo transfer (FET) were performed in both groups. Propensity score matching (1:1) was performed.
The primary outcomes were the dosage of MPA and the incidence of premature luteinizing hormone (LH) surges. The secondary outcomes were the number of oocytes retrieved, the cumulative live birth rate (CLBR) and the fetal malformation rate.
We created a perfect match of 478 patients in each group. The dosage of MPA, the LH serum level on the eighth day of stimulation, progesterone (P) level and LH level on the hCG trigger day were significantly higher in the LE + fixed MPA group than in the LE + degressive MPA group (52.1 ± 13.1 mg vs. 44.9 ± 12.5 mg; 5.0 ± 2.7 IU/L vs. 3.7 ± 1.7 IU/L; 0.9 ± 0.5 ng/ml vs. 0.8 ± 0.5 ng/ml; 3.3 ± 2.4 IU/L vs. 2.8 ± 1.9 IU/L; P < 0.01). The duration of Gn, the number of follicles with diameter more than 16 mm on trigger day, the estradiol (E2) level on the hCG trigger day were lower in the LE + fixed MPA group than in the LE + degressive MPA group (9.7 ± 1.7 days vs. 10.3 ± 1.5 days; 5.6 ± 3.0 vs. 6.3 ± 3.0; 1752.5 ± 1120.8 pg/ml vs. 1997.2 ± 1108.5 pg/ml; P < 0.001). No significant difference was found in the incidence of premature LH surge, the number of oocytes retrieved, the number of top-quality embryos, clinical pregnancy rate (CPR), CLBR or fetal malformation rate between the two groups.
The combination of a degressive MPA dose with LE proved effective in reducing the total MPA dosage with comparable premature LH surge and pregnancy outcomes in women undergoing the PPOS protocol.
A retrospective cohort study.
Tertiary-care academic medical center.
A total of 3173 infertile women undergoing their first in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatment within the period from January 2017 to December 2020.
A total of 1068 and 783 patients who underwent a fixed dose of MPA combined with LE and a degressive dose of MPA combined with LE protocols, respectively, were enrolled in this study. The freeze-all approach and later frozen-thawed embryo transfer (FET) were performed in both groups. Propensity score matching (1:1) was performed.
The primary outcomes were the dosage of MPA and the incidence of premature luteinizing hormone (LH) surges. The secondary outcomes were the number of oocytes retrieved, the cumulative live birth rate (CLBR) and the fetal malformation rate.
We created a perfect match of 478 patients in each group. The dosage of MPA, the LH serum level on the eighth day of stimulation, progesterone (P) level and LH level on the hCG trigger day were significantly higher in the LE + fixed MPA group than in the LE + degressive MPA group (52.1 ± 13.1 mg vs. 44.9 ± 12.5 mg; 5.0 ± 2.7 IU/L vs. 3.7 ± 1.7 IU/L; 0.9 ± 0.5 ng/ml vs. 0.8 ± 0.5 ng/ml; 3.3 ± 2.4 IU/L vs. 2.8 ± 1.9 IU/L; P < 0.01). The duration of Gn, the number of follicles with diameter more than 16 mm on trigger day, the estradiol (E2) level on the hCG trigger day were lower in the LE + fixed MPA group than in the LE + degressive MPA group (9.7 ± 1.7 days vs. 10.3 ± 1.5 days; 5.6 ± 3.0 vs. 6.3 ± 3.0; 1752.5 ± 1120.8 pg/ml vs. 1997.2 ± 1108.5 pg/ml; P < 0.001). No significant difference was found in the incidence of premature LH surge, the number of oocytes retrieved, the number of top-quality embryos, clinical pregnancy rate (CPR), CLBR or fetal malformation rate between the two groups.
The combination of a degressive MPA dose with LE proved effective in reducing the total MPA dosage with comparable premature LH surge and pregnancy outcomes in women undergoing the PPOS protocol.
摘要：
■通过倾向评分匹配（PSM）分析，探讨使用固定剂量与递减剂量的醋酸甲羟孕酮（MPA）联合来曲唑（LE）的孕激素引发的卵巢刺激（PPOS）的周期特征和妊娠结局。
■一项回顾性队列研究。
■三级护理学术医学中心。
在2017年1月至2020年12月期间，共有3173名不孕妇女接受了首次体外受精/卵胞浆内单精子注射（IVF/ICSI）治疗。
■总共1068和783名患者接受了固定剂量的MPA合并LE和递减剂量的MPA合并LE方案，分别,参加了这项研究。两组均进行了全部冷冻方法和后来的冻融胚胎移植（FET）。进行倾向评分匹配(1:1)。
■主要结果是MPA的剂量和黄体生成素（LH）过早激增的发生率。次要结果是检索到的卵母细胞数量，累计活产率(CLBR)和胎儿畸形率。
■我们创建了每组478名患者的完美匹配。MPA的用量,刺激第八天的LH血清水平，LE+固定MPA组hCG触发日的孕酮（P）水平和LH水平明显高于LE+递减MPA组（52.1±13.1mgvs.44.9±12.5mg;5.0±2.7IU/Lvs.3.7±1.7IU/L;0.9±0.5ng/mlvs.0.8±0.5ng/ml;3.3±2.4IU/Lvs.2.8±1.9IU/L；P<0.01）。Gn的持续时间,在触发日直径超过16毫米的卵泡数量，LE+固定MPA组hCG触发日雌二醇（E2）水平低于LE+递减MPA组（9.7±1.7天vs.10.3±1.5天；5.6±3.0天6.3±3.0;1752.5±1120.8pg/mlvs.1997.2±1108.5pg/ml；P<0.001）。早期LH激增的发生率没有显着差异，回收的卵母细胞数量，高质量胚胎的数量，临床妊娠率（CPR），两组间CLBR或胎儿畸形率。
■在接受PPOS方案的妇女中，递减的MPA剂量与LE的组合被证明可有效减少总MPA剂量，并具有可比的早期LH激增和妊娠结局。
■一项回顾性队列研究。
■三级护理学术医学中心。
在2017年1月至2020年12月期间，共有3173名不孕妇女接受了首次体外受精/卵胞浆内单精子注射（IVF/ICSI）治疗。
■总共1068和783名患者接受了固定剂量的MPA合并LE和递减剂量的MPA合并LE方案，分别,参加了这项研究。两组均进行了全部冷冻方法和后来的冻融胚胎移植（FET）。进行倾向评分匹配(1:1)。
■主要结果是MPA的剂量和黄体生成素（LH）过早激增的发生率。次要结果是检索到的卵母细胞数量，累计活产率(CLBR)和胎儿畸形率。
■我们创建了每组478名患者的完美匹配。MPA的用量,刺激第八天的LH血清水平，LE+固定MPA组hCG触发日的孕酮（P）水平和LH水平明显高于LE+递减MPA组（52.1±13.1mgvs.44.9±12.5mg;5.0±2.7IU/Lvs.3.7±1.7IU/L;0.9±0.5ng/mlvs.0.8±0.5ng/ml;3.3±2.4IU/Lvs.2.8±1.9IU/L；P<0.01）。Gn的持续时间,在触发日直径超过16毫米的卵泡数量，LE+固定MPA组hCG触发日雌二醇（E2）水平低于LE+递减MPA组（9.7±1.7天vs.10.3±1.5天；5.6±3.0天6.3±3.0;1752.5±1120.8pg/mlvs.1997.2±1108.5pg/ml；P<0.001）。早期LH激增的发生率没有显着差异，回收的卵母细胞数量，高质量胚胎的数量，临床妊娠率（CPR），两组间CLBR或胎儿畸形率。
■在接受PPOS方案的妇女中，递减的MPA剂量与LE的组合被证明可有效减少总MPA剂量，并具有可比的早期LH激增和妊娠结局。
