Application of progestin-primed ovarian stimulation scheme with different kinds of progesterone in patients at advanced age with decreased ovarian reserve
Objective:To explore the safety and effectiveness of progestin-primed ovarian stimulation(PPOS)with different kinds of progestin in IVF/ICSI cycles among patients at advanced age with diminished ovarian reserve(DOR).Methods:Infertility patients of advanced age with DOR,who underwent IVF/ICSI assisted pregnancy treatment using PPOS protocol(150 cycles in total)at Reproductive Center of Institute of Reproductive Medicine,Shunde Women & Children's Hospital of Guangdong Medical University from January 2023 to March 2024 were recruited.The patients were randomly assigned to three groups based on the type of progestin used as medroxyprogesterone acetate group(Group A),progesterone capsules group(Group B)and dydrogesterone group(Group C),with 50 patients in each group.The general characteristics,ovulation induction and embryonic laboratory indicators of three groups of patients were compared.Results:There were no significant differences in general characteristics among the three groups(P＞0.05).Similarly,no significant differences were found in total gonadotropin(Gn)dose,the duration of Gn used,estradiol(E2)and LH levels on the trigger day,follicle count,oocyte retrieval count,premature ovulation rate after trigger,and the number of good-quality embryos on Day 3(P＞0.05).The serum progesterone levels on the trigger day in Group B were significantly higher than those in other two groups[(24.19±16.74)nmol/L vs.(2.25±0.98)nmol/L,(5.93±2.19)nmol/L,P＜0.05].Although no statistical significance,Group B exhibited a trend towards a lower non-oocyte retrieval rate and higher MⅡrate,the fertilization rate,normal fertilization rate,and available embryo count when compared with the other groups(P＞0.05).Group C showed a tendency for a higher ovulation failure rate and non-available embryo rate,with no statistical significance similarly(P＞0.05).Conclusions:In DOR patients at advanced age undergoing the ovulation promotion with the PPOS protocol,the use of progesterone soft capsules yielded similar embryo outcomes compared to medroxyprogesterone acetate and dydrogesterone,indicating it can be considered as a viable clinical treatment option.
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维普
