生殖医学杂志

目的 探讨早发性卵巢功能不全(POI)患者芬吗通预处理自然周期促排卵方案的IVF临床结局。方法 回顾性分析2022年1月至2024年6月于同济大学附属同济医院生殖医学中心接受IVF-ET助孕治疗的174个周期的POI患者的临床资料。根据采用的不同促排卵方案分为4组，分别为拮抗剂方案组(n=43)、高孕激素状态下促排卵(PPOS)方案组(n=44)、微刺激方案组(n=42)及芬吗通预处理自然周期方案组(n=45)。比较4种不同方案组POI患者的促排卵结局和临床妊娠结局。结果 (1)一般临床资料：4种方案组间患者年龄、体质量指数(BMI)、基础性激素水平、抗苗勒管激素(AMH)水平、窦卵泡计数(AFC)等比较均无显著性差异(P>0.05)。(2)促排卵结局：自然周期方案组患者的Gn天数、获卵数和MⅡ卵率均显著低于其他3组(P<0.05);微刺激方案组患者的HCG日卵泡E₂水平显著低于其他3组(P<0.05);拮抗剂方案组患者的HCG日LH值显著低于其他3组(P<0.05);4组间2PN率和优胚率比较均无显著性差异(P>0.05)。(3)胚胎移植情况：拮抗剂方案组和自然周期方案组采用鲜胚移植和冻融胚胎移植，而其他两组仅采用冻融胚胎移植；自然周期方案组患者移植卵裂期胚胎占比显著高于其他3组(P<0.05);微刺激方案组患者的移植日内膜厚度显著低于其他3组(P<0.05);自然周期方案组移植1枚胚胎的周期占比显著高于其他3组(P<0.05)。(4)妊娠结局：4种不同促排卵方案组患者的移植周期取消率、生化妊娠率、临床妊娠率、双胎率比较均无显著差异(P>0.05)。结论 POI患者采用芬吗通预处理自然周期方案与拮抗剂方案、PPOS方案、微刺激方案相比可获得相似的妊娠结局，此方案可作为POI患者接受辅助生殖技术助孕治疗时的一种选择。

Objectives:To explore the outcomes of in vitro fertilization(IVF) with femoston pretreatment for natural cycle protocol in patients with premature ovarian insufficiency.Methods:A total of 174 cycles from patients with primary ovarian insufficiency(POI) who underwent IVF-embryo transfer(ET) treatment at Reproductive Medical Center of Tongji Hospital of Tongji University from January 2022 to June 2024 were retrospectively reviewed. According to the protocols of ovulation induction, they were divided into four groups as gonadotropin-releasing hormone(GnRH) antagonist protocol group(n=43),progestin primed ovarian stimulation(PPOS) protocol group(n=44),minimal stimulation protocol group(n=42) and nature cycle protocol with femoston pretreatment group(n=45). The ovulation induction outcomes and clinical outcomes of the four groups were compared.Results:As for the general clinical data, there were no significant differences in age, body mass index(BMI),levels of basal sex hormones, anti-Müllerian hormone(AMH) level, and antral follicle count(AFC) among the four groups of patients(P>0.05). Regarding the ovulation induction outcomes, the duration of gonadotropin(Gn) administration, number of retrieved oocytes, and MⅡ oocyte rate in the nature cycle protocol with femoston pretreatment group were significantly lower than those in the other three groups(P<0.05),the estradiol(E₂) level on the human chorionic gonadotropin(HCG) day in minimal stimulation protocol group was significantly lower than those in the other three groups(P<0.05),the luteinizing hormone(LH) level on the HCG day in GnRH antagonist protocol group was significantly lower than those in the other three groups(P<0.05),and there were no significant differences in the 2PN rate and high-quality embryo rate among the four groups(P<0.05). For embryo transfer outcomes, both GnRH antagonist protocol group and nature cycle protocol with femoston pretreatment group used fresh embryo transfer and freeze-thaw embryo transfer, while the other two groups only used freeze-thaw embryo transfer. The proportion of patients undergoing cleavage-stage embryo transfer in nature cycle protocol with femoston pretreatment group was significantly higher than those in the other three groups(P<0.05),the endometrial thickness on the transfer day in minimal stimulation protocol group was significantly thinner than those in the other three groups(P<0.05),the proportion of cycles with single-embryo transfer in nature cycle protocol with femoston pretreatment group was significantly higher than those in the other three groups(P<0.05). With regard to pregnancy outcomes, there were no statistically significant differences in the cancellation rate of transplantation cycles, biochemical pregnancy rate, clinical pregnancy rate and twin pregnancy rate among patients receiving the four different ovulation induction protocols(P>0.05).Conclusions:Compared with GnRH antagonist protocol, PPOS protocol, and minimal stimulation protocol, the natural cycle protocol pretreated with femoston results in similar pregnancy outcomes, so it can be used as an option for POI patients when they seek for assisted reproductive technology treatment.