使用progestin(PPOS, duphaston 20mg/d) vs GnRH agonist vs GnRH antagonist 應用於試管誘導排卵之LH抑制 -陽光婦產科暨生殖醫學中心-婦產科,台中婦產科,台中婦產科推薦

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使用progestin(PPOS, duphaston 20mg/d) vs GnRH agonist vs GnRH antagonist 應用於試管誘導排卵之LH抑制

本研究評估了黃體素促排卵方案 (PPOS)、促性腺激素釋放激素（GnRH）激動劑方案和促性腺激素釋放激素（GnRH）拮抗劑方案植入前非整倍體基因檢測 (PGT-A) 週期的整倍體率及懷孕結果。

整倍體囊胚率/MII卵母細胞比率在三組間相當(14.60% vs. 14.09% vs. 13.94%)

在生化妊娠、臨床妊娠、持續妊娠、著床率、流產率、異位妊娠率以及首次FET週期每次移植的活產率等妊娠結局方面，三組間均無顯著差異 (p > 0.05)。

PPOS 方案對整倍體囊胚形成沒有負面影響，

POS 方案的 FET 週期的懷孕結果與GnRH agonist 和 GnRH antagonist 懷孕結果相似

PPOS 有倒排卵時間較短排卵針劑量較低取卵數略低於GnRH agonist 和 GnRH antagonist

Analysis of euploidy rates in preimplantation genetic testing for aneuploidy cycles with progestin-primed versus GnRH agonist/antagonist protocol

This study evaluate euploidy rates and pregnancy outcomes in preimplantation genetic testing for aneuploidy (PGT-A) cycles using progestin-primed ovarian stimulation (PPOS) vs GnRH agonist vs GnRH antagonist protocol.

The euploid blastocyst rate per injected metaphase II(MII) oocytes (14.60% vs. 14.09% vs. 13.94%) was comparable among the three groups (p > 0.05).

No significant differences were observed among the three groups regarding pregnancy outcomes, including biochemical pregnancy, clinical pregnancy, ongoing pregnancy, implantation, miscarriage, ectopic pregnancy, and live birth rates per transfer in the first FET cycles (p > 0.05).

The PPOS protocol had no negative effect on euploid blastocyst formation, and the pregnancy outcomes in FET cycles using the PPOS protocol were similar to those of the GnRH agonist and antagonist protocols.

Variables	Ovarian stimulation protocol			p value
Variables	PPOS	GnRH agonist	GnRH antagonist	p value
No. of PGT-A cycles	146	160	302
Total dosage of Gn (IU)	1800(1575–2025)	2550(2071.86–3150)	2025(1593.75–2400)	0.000a,b,c
Duration of stimulation (days)	8(7–9)	11.5(10–13)	9(8–9)	0.000a,b,c
Oestradiol level on triggering day (pg/ml)	2420.92(1290–3533.49)	2641(1973.32–3668.44)	2017.36(1268.5–3017)	0.003c
Serum LH level on trigger day (IU/l)	3(1.94–5)	0.86(0.59–1.68)	2(1–3.29)	0.000a,b,c
Progesterone level on trigger day (ng/ml)	1(0.77–1)	0.98(0.71–1.26)	1(0.73–1.32)	0.588
Total No. of retrieved oocytes	1280	1892	2999
No. of retrieved oocytes	7(4–12)	12(7–15)	8(5–13)	0.000a,c
Total No. of MII	1062	1483	2374
No. of MII (n)	6(3–10)	9(6–12)	6(4–11)	0.000a,c
MII rate (%)	82.97%(1062/1280)	78.38%(1483/1892)	79.16%(2374/2999)	0.004a,b
Total No. of oocytes fertilised (n)	815	1014	1716
No. of oocytes fertilised (n)	4.5(2–8)	6(3–9)	5(3–8)	0.014a,c
Oocytes fertilised rate (%)*	76.74%(815/1062)	68.37%(1014/1483)	72.28(1716/2374)	0.000a,b,c
Total No. of cleaving embryos (n)	793	975	1668
Cleavage rate (%)*	97.3%(793/815)	96.15%(975/1014)	97.2%(1668/1716)	0.24
Total No. of blastocyst culture	765	996	1625
Total No. of blastocysts formation	333	454	723
No. of blastocysts formation (n)	2(0–3)	2(1–4)	2(1–4)	0.036a,c
Blastocysts formation rate (%)*	43.53%(333/765)	45.58%(454/996)	44.49%(723/1625)	0.687
Total No. of euploid blastocysts	155	209	331
No. of euploid blastocysts (n)	0(0–2)	1(0–2)	1(0–2)	0.084
Euploid blastocysts rate per biopsy (%)*	46.54%(155/333)	46.04%(209/454)	45.78%(331/723)	0.973
Euploid blastocysts rate per injected MII (%)*	14.60%(155/1062)	14.09%(209/1483)	13.94%(331/2374)	0.878
No. of PGT cycle with no blastocyst (%)	28.1%(41/146)	14.38%(23/160)	21.52%(65/302)	0.013a
No. of PGT cycle with no transferable blastocysts (%)*	51.37%(75/146)	38.75%(62/160)	47.02%(142/302)	0.074