Application Of Progestin-primed Ovarian Stimulation In Patients With Poor Ovarian Response

Poor ovarian response?POR?has become an important factor affecting the outcome of assisted reproduction in women with advanced age or low ovarian reserve function.It has been reported that in the process of assisted reproduction,about 5.6%³5.1%of patients will have POR.Currently,there are no clinical guidelines and consensus on the best assisted reproduction scheme for POR patients.Several commonly used ovulation induction schemes also have their own advantages and disadvantages,but micro-stimulation protocol are more commonly used than other schemes.Professor Kuang in 2015 put forward a new row of the promoting,progestin-primed ovarian stimulation?PPOS?scheme,the oral exogenous progesterone suppresses LH peak,while giving human menopausal gonadotrophin?hMG?stimulate ovulation,at present the scheme has been gradually popularized in the whole country,and can obtain satisfactory clinical outcomes,but there are number of clinical research mainly choose more normal ovarian reaction infertility patients than POR patients.Therefore,this paper mainly discusses the comparison of the clinical application value of micro-stimulation protocol and PPOS in patients with low ovarian response,and conducts an in-depth study on the application value of PPOS in patients with low ovarian response at different ages.Part? The effect of PPOS and micro-stimulation protocol on the clinical efficacy of patients with poor ovarian responseObjective:To compare the clinical efficacy of PPOS and micro-stimulation protocol in patients with poor ovarian response.Methods:A total of 990 cycles of patients with poor ovarian response who underwent in vitro fertilization and embryo transfer?IVF/ICSI-ET?in our hospital from January 2018 to October 2019.All cycles were divided into two groups:PPOS group had 434 cycles and the micro-stimulation protocol group had 556 cycles.To compare the general conditions,clinical indicators,oocyte and embryo related indicators,and clinical pregnancy outcomes of freeze-thaw embryo transfer?FET?cycle between the two groups.Results:Compared with the micro-stimulation protocol,the total gonadotropin?Gn?content in the PPOS[?2821.23±996.56?U vs.?2499.36±626.96?U]was significantly increased?P<0.05?.Gn days[?10.69±2.73?d vs.?11.10±2.29?d],HCG days E₂[?1664.31±1108.80?pg/ml vs.?1859.99±1298.67?pg/ml],HCG days LH[?3.38±2.79?pg/ml vs.?10.57±10.39?pg/ml],HCG days dominant follicles[?4.39±2.36?vs.?4.71±2.24?]all decreased?P<0.05?.For egg number[?3.80±2.33?vs.?3.48±2.02?],the number of 2PN[?2.18±1.78?vs.?1.92±1.59?],attains the egg rate[86.66%vs.73.84%],the high quality rate of embryos[46.32%vs.41.39%]were significantly increased?P<0.05?.The rate of the clinical pregnancy was higher in PPOS[46.89%vs.41.98%]than micro-stimulation protocol,but the difference was not statistically significant?P>0.05?.While the peak rate of early-onset LH[2.53%vs.40.47%],and the cycle cancellation rate[19.12%vs.24.28%]were significantly reduced?P<0.05?.Conclusion:PPOS ovulation induction scheme can not only effectively inhibit the early onset LH peak and control the cycle cancellation rate in POR patients,but also increase the egg acquisition rate and improve the embryo quality to a certain extent,and obtain a certain clinical pregnancy rate.Part? The effect of PPOS on the clinical efficacy of patients with poor ovarian response at different agesObjective:To compare the clinical efficacy of PPOS in patients with poor ovarian response at different ages.Methods:434 patients in the PPOS protocol group were divided into four groups according to age:?30 years old group?n=63?,30 years old<age?35 years old group?n=164?,35 years old<age?40 years old group?n=108?,and>40 years old group?n=99?.A total of 179 patients underwent FET cycles in 434 patients,among which two patients had no transplantation,so there were 177 FET cycles,which were divided into four groups according to age:?30 years old group?n=29?,30 years old<age?35 years old group?n=63?,35 years old<age?40 years old group?n=55?,and>40 years old group?n=30?.To compare the general conditions,clinical indicators,oocyte and embryo related indicators,and clinical pregnancy outcomes of FET cycle among the four groups.Results:Comparison of baseline date of patients in four groups showed that the general conditions of patients in>40 years old group was worse.Basal FSH was higher than the other three groups,and AFC was lower than the other three groups,with no statistical difference in the other three groups?P>0.05?.The number of HCG day E₂and HCG day dominant follicles in>40 years old group was lower than that in the other three groups,with statistical difference?P<0.05?,while there was no statistical difference between the other three groups?P>0.05?.The HCG day LH of>40 years old group was higher than?30 years old group and 30 years old<age?35 years old group,with statistical difference?P<0.05?,while there was no statistical difference between the other groups?P>0.05?.The number of obtained eggs,number of mature oocytes,number of 2PN,number of transplantable embryos and number of high-quality embryos in>40 years old group were all lower than those in the other three groups?P<0.05?,while the differences among the other three groups were not statistically significant?P>0.05?.No significant difference was found in the intima thickness and the number of transplanted embryos in FET among four groups?P>0.05?.The pregnancy rate of>40 years old group was significantly lower than the other three groups?P<0.05?,while the pregnancy rate of the other three groups showed no statistical difference?P>0.05?.Conclusion:Age is an independent factor affecting the clinical outcome of pregnancy.With age increasing,the number of eggs obtained,the number of mature oocytes,the number of 2PN and the number of translatable embryos in IVF/ICSI-ET decreased,and the clinical pregnancy rate in FET cycle decreased,except for the general conditions such as decreased AFC and increased basal FSH of POR patients with PPOS.