PDF(Pubmed)
Abstract：
The aim of this study was to evaluate the effects of medroxyprogesterone acetate (MPA) treatment in comparison to those of gonadotropin releasing hormone (GnRH) antagonists for the prevention of premature luteinizing hormone surges during controlled ovarian hyperstimulation (OS) and the impact of these effects on developing embryos and pregnancy outcomes. Data from 757 cycles of GnRH antagonist treatment and 756 cycles of MPA treatment were evaluated at the Akdeniz University Faculty of Medicine Assisted Reproductive Treatment Center between October 2018 and April 2022. Patient records were obtained from the electronic database of the centre and analysed. In our centre, GnRH antagonist protocols were used between 2018 and 2020, and MPA protocols were used between 2020 and 2022. We chose our study population by year. Our study is a comparative retrospective study. All methods in this study were performed in accordance with the relevant guidelines and regulations. Patients using MPA were significantly older (33.9 ± 5.6 vs. 32.6 ± 5.6, p < 0.001) and had a lower number of antral follicles (AFC) (10.7 ± 8.6 vs. 11.9 ± 10.8, p = 0.007) than those using GnRH antagonists. Both MPA (2.9%) and GnRH antagonists (2.2%) had similar effectiveness in preventing premature ovulation (p = 0.415). There was no significant difference between the two groups in terms of the number of total developed embryos (1.3 ± 1.3 vs. 1.2 ± 1.2, p = 0.765). There was no significant difference in the clinical pregnancy rates with the first ET (%35.4 vs. %30.1, p = 0.074), per total number of transfers (35.3% vs. 30.1%, p = 0.077). MPA was found to be effective at preventing premature ovulation during OS treatment, and the incidence of developing embryo and pregnancy outcomes in patients using MPA were similar to those in patients using GnRH antagonists. Therefore, the use of MPA instead of GnRH antagonists during OS may be a viable alternative for patients not scheduled for fresh ET.
摘要：
这项研究的目的是评估与促性腺激素释放激素（GnRH）拮抗剂相比，醋酸甲羟孕酮（MPA）治疗对预防控制性卵巢过度刺激（OS）期间黄体生成素过早激增的影响以及这些影响对发育胚胎和妊娠结局的影响。2018年10月至2022年4月，在Akdeniz大学医学院辅助生殖治疗中心评估了757个GnRH拮抗剂治疗周期和756个MPA治疗周期的数据。从中心的电子数据库获得患者记录并进行分析。在我们的中心,GnRH拮抗剂方案在2018年至2020年之间使用，MPA方案在2020年至2022年之间使用。我们按年份选择了我们的研究人群。我们的研究是一项比较回顾性研究。本研究中的所有方法均按照相关指南和规定进行。使用MPA的患者年龄明显较大（33.9±5.6vs.32.6±5.6，p<0.001），并且窦状卵泡（AFC）的数量较低（10.7±8.6vs.比使用GnRH拮抗剂的11.9±10.8，p=0.007）。MPA（2.9％）和GnRH拮抗剂（2.2％）在预防过早排卵方面具有相似的有效性（p=0.415）。两组在发育胚胎总数方面没有显着差异（1.3±1.3vs.1.2±1.2，p=0.765）。首次ET的临床妊娠率没有显着差异（％35.4vs.%30.1，p=0.074），每转账总数（35.3%与30.1%,p=0.077)。发现MPA在OS治疗期间可有效预防过早排卵，使用MPA的患者的胚胎发育发生率和妊娠结局与使用GnRH拮抗剂的患者相似。因此,在OS期间使用MPA代替GnRH拮抗剂可能是未计划进行新鲜ET的患者的可行替代方案。
