| Background & ObjectivePoor ovarian response refers to the pathological state in which the ovary does not respond well to gonadotropin stimulation in the process of controlled ovarian hyper-stimulation.Because of its small number of oocytes obtained and low pregnancy rate in patients with POR,it is one of the most challenging problems in assisted reproductive technology.With the change of national fertility policy,the general postponement of women's childbearing age,the number of women who want to have children is increasing year by year,and poor ovarian response has become an urgent bottleneck in the field of assisted reproduction.It is a new direction to study the treatment of patients with POR that how to obtain sufficient and high-quality oocytes from the limited ovarian reserves of POR patients for IVF/ICSI,and at the same time reduce the use of ovarian stimulation drugs and suppress premature LH surges.In recent years,some scholars have proposed that the exogenous progestin primed ovarian stimulation in the follicular phase can not only enable patients to obtain oocytes in a short time,but also suppress premature LH surges.This new use of progesterone suppresses premature LH surges and provides a new direction for controlled ovarian hyper-stimulation.Therefore,whether this new ovulation induction program can improve the response of POR patients during ovarian stimulation is worthy of our further observation and study.The purpose of this study was to compare the treatment effects of using exogenous 10 mg medroxyprogesterone acetate in follicular phase ovarianstimulation and luteal phase ovarian stimulation with endogenous high progesterone in patients with poor ovarian response.Materials & Research MethodsA total of 270 cycles of POR patients who accepted IVF/ICSI-ET in the reproductive center of the third affiliated Hospital of Guangzhou Medical University from January 01,2018 to December 31,2019 were selected.Among them,there were 168 cycles in PPOS regimen and 102 cycles in LPS regimen.The treatment effects of using exogenous 10 mg medroxyprogesterone acetate in follicular phase ovarian stimulation and luteal phase ovarian stimulation with endogenous high progesterone in patients with poor ovarian response were retrospectively analyzed.The entry criteria were IVF/ICSI-ET indications and POR patients who meet the Bologna criteria:(1)advanced maternal age(? 40 years old)or any other risk factors of poor ovarian response(such as pelvic infection,ovarian endometriosis cyst,previous ovarian surgery,history of radiotherapy and chemotherapy);(2)poor ovarian response(no more than 3 oocytes obtained)in conventional ovarian stimulation regimens;(3)decreased ovarian reserve(AFC < 5-7 or AMH <0.5-1.1ng/m L).At least 2 of the above 3 items can be diagnosed as POR.Grouping criteria: according to the different ovarian stimulation,the patients were divided into two groups: using exogenous 10 mg medroxyprogesterone acetate in follicular phase ovarian stimulation and luteal phase ovarian stimulation with endogenous high progesterone.Results1.Comparison of general conditions between the two groups: there was no statistically significant difference in age,years of infertility,BMI,AMH,b FSH,b LH and types of infertility between PPOS group and LPS group.It shows that the data of the two groups are comparable.2.Comparison of the results of ovarian stimulation between the two groups: the duration days of Gn and the total amount of Gn in the PPOS group were significantly lower than those in the LPS group,which were(8.31±2.27 vs.9.60±2.60;P<0.001)and(1433.53±629.18 vs.1955.39±745.71;P<0.001),respe ctively.The P level and endometrial thickness on HCG day in PPOS group were significantly lower than those in LPS group(1.19 ±0.78 vs.16.11±24.92;P < 0.001;5.74 ±4.35 vs.8.67 ±3.01;P < 0.001,respectively).The LH level on HCG day in PPOS group(4.59 ±2.39)was significantly higher than that in LPS group(3.86 ±1.90).The average number of oocytes obtained and the cycle rate of oocytes unobtained in PPOS group and LPS group were similar.The premature LH surge was suppressed in both PPOS group and LPS group,and the incidence of premature LH surge in PPOS group was 1.78%(3/168),and no premature LH surge was found in LPS group.No OHSS was found in PPOS group and LPS group.3.Comparison of embryo culture between the two groups: the average number of fertilized oocytes,average number of normal fertilized oocytes,average number of cleavage oocytes,average number of 2PN cleavage,average number of frozen embryos,IVF/ICSI fertilization rate,IVF/ICSI normal fertilization rate,cleavage rate,2PN cleavage rate,available embryo rate and no available embryo cycle rate were similar between PPOS group and LPS group.4.Factor analysis of no available embryos in the two groups: the main reason for no available embryos in PPOS group and LPS group was poor embryo quality(38.46% vs.45.16%),followed by unfertilized(23.07%vs.22.58%).5.Comparison of thawing cycles between the two groups: the endometrial thickness on the conversion day in the PPOS group was significantly higher than that in the LPS group(9.43±2.10 vs.8.45±1.99;P < 0.05).6.Comparison of frozen-thawed embryo transfer outcome between the two groups: there was no statistically significant difference in the survival rate of thawed embryos,the average number of transferred embryos,biochemical pregnancy rate,clinical pregnancy rate,embryo implantation rate,loss rate of early pregnancy,continuous pregnancy rate,twin pregnancy rate between PPOS group and LPS group.The outcome of frozen-thawed embryo transfer was similar in PPOS group and LPS group.7.There was no significant difference in the data of different days of embryo transfer between PPOS group and LPS group.The positive rate of HCG and clinical pregnancy rate in D3/D4 group and D5/D6 group were similar.Conclusion1.In patients with poor ovarian response,10 mg medroxyprogesterone acetate high progesterone ovarian stimulation in the follicular phase can achieve cycle results similar to those in the luteal phase.2.In patients with poor ovarian response,PPOS protocol can achieve shorter cycle time of ovarian stimulation and less drug consumption than LPS protocol.3.In patients with poor ovarian response,both PPOS and LPS protocols could suppress the premature LH surge.4.In patients with poor ovarian response,the clinical outcome of PPOS protocol was similar to that of LPS protocol.5.In patients with poor ovarian response,the PPOS protocol is one of the recommended protocol. |
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