An Individualized Recommendation for Controlled Ovary Stimulation Protocol in Women Who Received the GnRH Agonist Long-Acting Protocol or the GnRH Antagonist Protocol: A Retrospective Cohort Study.
An Individualized Recommendation for Controlled Ovary Stimulation Protocol in Women Who Received the GnRH Agonist Long-Acting Protocol or the GnRH Antagonist Protocol: A Retrospective Cohort Study.
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DOI：
10.3389/fendo.2022.899000
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发表时间：
2022
影响因子：
5.2
通讯作者：
中科院分区：
文献类型：
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GnRH激动剂长效方案和GnRH拮抗剂方案广泛用于促排卵。对于不同年龄、不同卵巢储备、不同体重指数的IVF/ICSI患者，哪种方案能获得较高的活产率尚未研究。然而，在这些方案中，在不同年龄、卵巢储备和体重指数（BMI）的IVF/ICSI患者中，哪一种方案能提高活产率尚未确定。这是一项回顾性队列研究，涉及2018年1月至2021年8月期间接受首次IVF-ET的8579名女性。倾向评分匹配（PSM）被用来提高两个协议之间的可比性。PSM后，GnRH激动剂长效方案的活产率显著高于GnRH拮抗剂方案（44.04% vs. 38.32%）（p<0.001）。分层分析显示，AMH水平在3 ~ 6 ng/ml、BMI ≥ 24 kg/m2、年龄≥ 30岁的妇女，以及AMH水平≤ 3 ng/ml、BMI <24 kg/m2、年龄≥30岁的妇女，GnRH激动剂长效方案更可能获得活产[OR（95%CI），2.13（1.19，3.80）]，[OR（95%CI），1.41（1.05，1.91）]。但在BMI ≥ 24 kg/m2、年龄≥30岁、AMH水平≤ 3 ng/ml的妇女中，GnRH激动剂长效方案诱导活产的可能性较低[OR（95%CI），0.54（0.32，0.90）]。此外，AMH水平在3 ng/ml和6 ng/ml之间，BMI ≥ 24 kg/m2且年龄< 30岁的女性，以及AMH水平在3 ng/ml和6 ng/ml之间（不考虑年龄）且BMI<24 kg/m2的女性，两种方案的活产可能性相似[OR（95%CI），1.06（0.60，1.89）]，[OR（95%CI），1.38（0.97，1.97）]，[OR（95%CI），0.99（0.72，1.37）]。AMH水平≤ 3 ng/ml且年龄<30岁的孕妇，无论BMI如何，两种方案活产的可能性相似[OR（95%CI），1.02（0.68，1.54）]，[OR（95%CI），1.43（0.68，2.98）]。AMH水平≥ 6 ng/ml的孕妇，两种方案的活产率相似[OR（95%CI），1.42（0.75，2.69）]，[OR（95%CI），1.02（0.19，5.35）]，[OR（95%CI），1.68（0.81，3.51）]，[OR（95%CI），0.51（0.10，2.55）]。GnRH激动剂长效方案或GnRH拮抗剂方案对不孕症患者的适用性取决于患者的特定生物学特征。
The GnRH agonist long-acting protocol and GnRH antagonist protocol are widely used in ovarian stimulation. Which protocol eliciting higher live birth rate for IVF/ICSI patients with different ages, different ovarian reserves and different body mass index (BMI) has not been studied. However, among these protocols, the one that elicits higher live birth in IVF/ICSI patients with different ages, ovarian reserves and body mass indexes (BMI) has not been identified. This was a retrospective cohort study about 8579 women who underwent the first IVF-ET from January, 2018 to August, 2021. Propensity Score Matching (PSM) was used to improve the comparability between two protocols. After PSM, significant higher live birth rates were found in the GnRH agonist long-acting protocol compared to GnRH antagonist protocol (44.04% vs. 38.32%) (p<0.001). Stratified analysis showed that for those with AMH levels between 3 ng/ml and 6 ng/ml, with BMI ≥ 24 kg/m2 and were aged ≥ 30 years old, and for those women with BMI < 24kg/m2 and were aged ≥30 years whose AMH levels were ≤ 3ng/ml, the GnRH agonist long-acting protocol was more likely to elicit live births [OR (95%CI), 2.13(1.19,3.80)], [OR (95%CI), 1.41(1.05,1.91)]. However, among women with BMI ≥ 24kg/m2 and were aged ≥30 years whose AMH levels were ≤ 3ng/ml, the GnRH agonist long-acting protocol had a lower possibility of eliciting live births [OR (95%CI), 0.54(0.32,0.90)]. Also, among women with AMH levels between 3 ng/ml and 6 ng/ml, with BMI ≥ 24 kg/m2 and with age < 30 years and for those with AMH levels between 3 ng/ml and 6 ng/ml, regardless of age, and with BMI<24kg/m2,, the possibility of live births was similar between the two protocols [OR (95%CI), 1.06(0.60,1.89)], [OR (95%CI), 1.38(0.97,1.97)], [OR (95%CI), 0.99(0.72,1.37)]. Among the women with AMH levels ≤ 3 ng/ml and with were aged < 30years, regardless of BMI, the possibility of live birth was similar between the two protocols [OR (95%CI), 1.02(0.68,1.54)], [OR (95%CI), 1.43(0.68,2.98)]. Moreover, among women with AMH levels ≥ 6ng/ml, the possibility of live birth was similar between the two protocols [OR (95%CI),1.42(0.75,2.69)], [OR (95%CI),1.02(0.19,5.35)], [OR (95%CI), 1.68(0.81,3.51)], [OR (95%CI), 0.51(0.10,2.55)]. The suitability of the GnRH agonist long-acting protocol or GnRH antagonist protocol to infertility patients is dependent on specific biological characteristics of the patients.
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影响因子：
2.1
作者：
Keane, Kevin;Cruzat, Vincius Fernandes;Yovich, John
通讯作者：
Yovich, John
影响因子：
5.2
作者：
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通讯作者：
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影响因子：
2
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影响因子：
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作者：
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通讯作者：
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影响因子：
3.4
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通讯作者：
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