Outcomes of fertility preservation in women with endometriosis: comparison of progestin-primed ovarian stimulation versus antagonist protocols
Outcomes of fertility preservation in women with endometriosis: comparison of progestin-primed ovarian stimulation versus antagonist protocols
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DOI：
10.1186/s13048-020-00620-z
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发表时间：
2020-02-13
影响因子：
4
通讯作者：
Bendifallah, Sofiane
中科院分区：
文献类型：
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作者：
d'Argent, Emmanuelle Mathieu;Ferrier, Clement;Bendifallah, Sofiane
与拮抗剂方案相比，PPOS方案最初用于癌症妇女的FP治疗，具有许多优势。未对子宫内膜异位症患者的PPOS方案进行评估。该研究的目的是描述子宫内膜异位症女性的生育能力保存结果，并比较拮抗剂方案和黄体酮刺激卵巢（PPOS）方案。方法在某大学三级医院进行前瞻性队列研究，并进行成本-效果分析。测量的结果包括取出和玻璃化卵母细胞的数量，以及直接医疗费用。在整个群体中，进行了独特和多元线性回归分析，以寻找个体特征与检索到的卵母细胞数量之间的相关性。结果我们纳入了108名子宫内膜异位症患者，她们接受了单一刺激周期的拮抗剂或PPOS方案。总体而言，每位患者取出8.1 +/- 6.6个卵母细胞，玻璃化6.4 +/- 5.6个卵母细胞。在多元回归模型中，年龄（p = 0.001）、既往卵巢手术（p = 0.035）和抗苗勒管激素水平（p = 0.001）与取出的卵母细胞数量相关。54名女性采用拮抗剂方案，54名采用PPOS方案。拮抗剂组平均回收7.9 +/- 7.4个卵母细胞，PPOS组平均回收8.2 +/- 5.6个卵母细胞（p = 0.78）。拮抗剂组平均6.4 +/- 6.4个卵母细胞玻璃化，PPOS组平均6.4 +/- 4.7个卵母细胞玻璃化（p = 1）。在成本-效果分析中，PPOS方案明显优于拮抗剂方案。结论子宫内膜异位症患者保留生育能力是可行和有效的。拮抗剂和PPOS方案的结果相似，但医学经济学分析支持PPOS方案。
Background PPOS protocols, initially described for FP in women with cancer, have many advantages compared to antagonist protocols. PPOS protocols were not evaluated for women with endometriosis. The objective of the study was to describe fertility preservation outcomes in women with endometriosis and to compare an antagonist protocol with a Progestin-Primed Ovarian Stimulation (PPOS) protocol. Method We conducted a prospective cohort study associated with a cost-effectiveness analysis in a tertiary-care university hospital. The measured outcomes included the numbers of retrieved and vitrified oocytes, and direct medical costs. In the whole population, unique and multiple linear regressions analysis were performed to search for a correlation between individual characteristics and the number of retrieved oocyte. Results We included 108 women with endometriosis who had a single stimulation cycle performed with either an antagonist or a PPOS protocol. Overall, 8.1 +/- 6.6 oocytes were retrieved and 6.4 +/- 5.6 oocytes vitrified per patient. In the multiple regression model, age (p = 0.001), prior ovarian surgery (p = 0.035), and anti-Mullerian hormone level (p = 0.001) were associated with the number of retrieved oocytes. Fifty-four women were stimulated with an antagonist protocol, and 54 with a PPOS protocol. A mean of 7.9 +/- 7.4 oocytes were retrieved in the antagonist group and 8.2 +/- 5.6 in the PPOS group (p = 0.78). A mean of 6.4 +/- 6.4 oocytes were vitrified in the antagonist group and 6.4 +/- 4.7 in the PPOS group (p = 1). In the cost-effectiveness analysis, the PPOS protocol was strongly dominant over the antagonist protocol. Conclusion Fertility preservation procedures are feasible and effective for patients affected by endometriosis. Antagonist and PPOS protocols were associated with similar results but the medico-economic analysis was in favor of PPOS protocols.