The pregnancy outcome of progestin-primed ovarian stimulation using 4 versus 10 mg of medroxyprogesterone acetate per day in infertile women undergoing in vitro fertilisation: a randomised controlled trial
The pregnancy outcome of progestin-primed ovarian stimulation using 4 versus 10 mg of medroxyprogesterone acetate per day in infertile women undergoing in vitro fertilisation: a randomised controlled trial
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每天使用 4 毫克与 10 毫克醋酸甲羟孕酮进行孕激素引发的卵巢刺激对接受体外受精的不孕妇女的妊娠结局：一项随机对照试验
DOI：
10.1111/1471-0528.14622
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发表时间：
2017-06-01
影响因子：
5.8
通讯作者：
Kuang, Y. P.
中科院分区：
文献类型：
--
作者：
Dong, J.;Wang, Y.;Kuang, Y. P.
目的探讨孕激素促排卵（PPOS）治疗卵巢储备功能正常的不孕妇女的临床结局和内分泌学特征。方法从周期第3天开始同时给予人绝经期促性腺激素（hMG; 225 iu/d）和MPA（A组，10 mg/d; B组，4 mg/d）。当优势卵泡成熟时，由人绒毛膜促性腺激素（hCG; 1000 iu）和促性腺激素释放激素激动剂（GnRH激动剂; 0.1 mg）共同触发排卵。在两组中，活的胚胎被冷冻保存用于以后的冷冻胚胎移植（FET）。主要结果测量主要结果测量是获得的卵母细胞的数量。次要结果包括促黄体生成激素（LH）过早激增的发生率、存活胚胎数和临床妊娠结局。结果两组间获卵数和存活胚胎数相似（9.8 +/- 6.3 vs 9.6 +/- 5.9; 4.2 +/- 2.6 vs 3.7 +/- 3.0; P > 0.05）。临床妊娠率（58.0%对48.7%）和活产率（48.7%对42.0%; P > 0.05）无显著差异。两组均未出现LH峰和卵巢过度刺激综合征（OHSS）。结论孕酮预激卵巢刺激（PPOS）使用MPA 4或10 mg/d，在FET后获卵数和妊娠结局方面具有可比性。每天给予4 mg MPA足以防止接受IVF/ICSI治疗的女性出现LH过早升高。
Objective To investigate the clinical outcome and endocrinological characteristics of progestin-primed ovarian stimulation (PPOS) using 4 versus 10 mg of medroxyprogesterone acetate (MPA) per day in infertile women with normal ovary reserve.Design A randomised parallel controlled trial.Setting Tertiary-care academic medical centre.Participants A cohort of 300 infertile women undergoing in vitro fertilisation (IVF)/intracytoplasmic sperm injection (ICSI) treatment.Methods Human menopausal gonadotropin (hMG; 225 iu per day) and MPA (group A, 10 mg per day; group B, 4 mg per day) were started simultaneously from cycle day 3 onwards. Ovulation was co-triggered by human chorionic gonadotropin (hCG; 1000 iu) and gonadotropin-releasing hormone agonist (GnRH agonist; 0.1 mg) when dominant follicles matured. Viable embryos were cryopreserved for later frozen embryo transfer (FET) in both groups.Main outcome measures The primary outcome measure was the number of oocytes retrieved. Secondary outcomes included the incidence of a premature surge in luteinising hormone (LH), the number of viable embryos, and clinical pregnancy outcomes.Results The number of oocytes retrieved and viable embryos were similar between two groups (9.8 +/- 6.3 versus 9.6 +/- 5.9; 4.2 +/- 2.6 versus 3.7 +/- 3.0; P > 0.05). No significant difference was found in clinical pregnancy rate (58.0 versus 48.7%) and live birth rate per participant (48.7 versus 42.0%; P > 0.05). No premature LH surge and ovarian hyperstimulation syndrome (OHSS) occurred in either group.Conclusions Progestin-primed ovarian stimulation (PPOS) using 4 or 10 mg of MPA per day was comparable in terms of the number of oocytes retrieved and pregnancy outcome after FET. The administration of 4 mg of MPA per day was sufficient to prevent an untimely LH rise in women undergoing IVF/ICSI treatment.