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目的 比较卵泡期长方案和卵泡期高孕激素状态下促排卵(PPOS)方案在卵巢储备功能减退(DOR)人群中的助孕治疗效果。方法 回顾性分析2018年1月至2025年6月于我院生殖医学中心行体外受精/卵胞浆内单精子注射(IVF/ICSI)助孕的DOR患者病例资料(共614个取卵周期)。根据年龄分为<35岁组(n=274)和≥35岁组(n=340),再根据促排卵方案的不同分为卵泡期长方案亚组(A1组<35岁，n=107;A2组≥35岁，n=115)和PPOS方案亚组(B1组<35岁，n=167;B2组≥35岁，n=225),比较同年龄组中两亚组患者(A1 vs. B1;A2 vs. B2)的促排卵情况、冻融胚胎移植(FET)周期的临床结局以及获得妊娠/活产的时间成本。结果 同年龄组中两亚组患者的基础资料比较均无显著性差异(P>0.05)。促排卵结局比较：与B1组相比，A1组患者的Gn用量大、Gn用时长、获卵数多、MⅡ卵数多，而优胚率低，差异均有统计学意义(P<0.05);与B2组相比，A2组患者的Gn用量大、Gn用时长、获卵数多、MⅡ卵数多，差异亦均有统计学意义(P<0.05),但两亚组优胚率相当(P>0.05)。妊娠结局比较：FET周期中同年龄组两亚组患者的临床妊娠率、流产率、活产率、早产率和累积临床妊娠率、累积活产率均无显著性差异(P>0.05);但A1组首次临床妊娠所需时间显著低于B1组(P<0.05),A2组首次临床妊娠/活产所需时间均显著低于B2组(P<0.05)。结论 年轻DOR不孕患者行IVF/ICSI助孕时，卵泡期长方案和PPOS方案均可获得较好的妊娠结局；高龄DOR不孕患者，卵泡期长方案可获得较高的累积临床妊娠率和累积活产率，且所花费的时间成本较低。
Abstract：Objectives:To compare the treatment effect of the long-acting gonadotropin-releasing hormone(GnRH) agonist follicular protocol and progestin-primed ovarian stimulation(PPOS) in patients with diminished ovarian reserve(DOR).Methods:A retrospective analysis was conducted on the data of DOR infertile patients treated with in vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI) at the reproductive medicine center of Jiangmen Central Hospital between January 2018 and June 2025.There were 614 oocyte retrieval cycles in total. The patients were divided into <35 years group(n=274) and ≥35 years group(n=340) based on their ages. And then depending on the different regimens, patients were further divided into the long-acting GnRH agonist follicular protocol subgroup(group A1,<35 years old, n=107 and group A2,≥35 years old, n=115) and the PPOS protocol subgroup(group B1,<35 years old, n=167 and group B2,≥35 years old, n=225). The ovarian stimulation, clinical outcomes of frozen-thawed embryo transfer(FET) cycles and the time of attaining pregnancy/live birth were compared between the two subgroups of patients at the same age(A1 vs. B1 and A2 vs. B2).Results:The basic characteristics were comparable in the two subgroups at the same age(P>0.05). The outcomes of ovarian stimulation found that compared with group B1,group A1 had higher total dose of gonadotropin(Gn) use, longer duration of Gn use, more retrieval oocytes and MⅡ oocytes, but lower high-quality embryo rate, showing statistically significant differences(P<0.05). Compared with group B2,group A2 had significantly higher total dose of gonadotropin(Gn) use, longer duration of Gn use, more retrieval oocytes and MⅡ oocytes(P<0.05),but the rate of high-quality embryos were comparable between the two groups(P>0.05). As to the pregnancy outcomes in FET cycles, there were no significant differences in the clinical pregnancy rate, the miscarriage rate, the live birth rate, the preterm birth rate, the cumulative clinical pregnancy rate, and the cumulative live-birth rate between the two subgroups of patients at the same age(P>0.05). However, the time of obtaining the first clinical pregnancy in group A1 was significantly shorter than that of group B1(P<0.05),and group A2 had dominant advantages in the time of obtaining the first clinical pregnancy and first live-birth when compared with group B2(P<0.05).Conclusions:For the younger DOR infertile patients treated by IVF/ICSI,both long-acting GnRH agonist follicular protocol and PPOS one can achieve better pregnancy outcomes. For advanced DOR patients, long-acting GnRH agonist follicular protocol can obtain higher cumulative clinical pregnancy rate and the cumulative live birth rate, with a relatively shorter time.
[1] 卵巢储备功能减退临床诊治专家共识专家组，中华预防医学会生育力保护分会生殖内分泌生育保护学组.卵巢储备功能减退临床诊治专家共识[J].生殖医学杂志，2022,31:425-434.
[2] Pastore LM,Christianson MS,Stelling J,et al.Reproductive ovarian testing and the alphabet soup of diagnoses:DOR,POI,POF,POR,and FOR[J].J Assist Reprod Genet,2018,35:17-23.
[3] Orvieto R.Stop GnRH-agonist/GnRH-antagonist protocol:a different insight on ovarian stimulation for IVF[J].Reprod Biol Endocrinol,2023,21:13.
[4] Mandelbaum RS,Melville S,Masjedi A,et al.Clomiphene citrate throughout the duration of ovarian stimulation in patients with diminished ovarian reserve:an approach to decrease costs,reduce injection burden,and prevent premature ovulation[J].J Assist Reprod Genet,2025,42:791-797.
[5] Tu X,You B,Jing M,et al.Progestin-primed ovarian stimulation versus mild stimulation protocol in advanced age women with diminished ovarian reserve undergoing their first in vitro fertilization cycle:A retrospective cohort study[J].Front Endocrinol (Lausanne),2022,12:801026.
[6] Jiao Z,Bukulmez O.Potential roles of experimental reproductive technologies in infertile women with diminished ovarian reserve[J].J Assist Reprod Genet,2021,38:2507-2517.
[7] Zhu Q,Li Y,Ma J,et al.Potential factors result in diminished ovarian reserve:a comprehensive review[J].J Ovarian Res,2023,16:208.
[8] Zeng Y,Zhang Y,Cao Q,et al.Independent predictors and thresholds of in vitro fertilization outcomes in patients with diminished ovarian reserve[J].Sci Rep,2025,15:18875.
[9] Yang R,Guan Y,Perrot V,et al.Comparison of the long-acting GnRH agonist follicular protocol with the GnRH antagonist protocol in women undergoing in vitro fertilization:a systematic review and meta-analysis[J].Adv Ther,2021,38:2027-2037.
[10] 李敏，曾品鸿.卵巢储备功能正常人群卵泡期GnRH-a长方案不同时期添加尿促性腺激素对临床结局的影响[J].生殖医学杂志，2023,32:19-24.
[11] 李婷婷，陈攀宇，刘晓娉，等.长效GnRH激动剂与GnRH拮抗剂促排卵方案在反复种植失败患者中的临床应用[J].生殖医学杂志，2023,32:652-658.
[12] Zhu S,Jiang W,Liao X,et al.Effect of diminished ovarian reserve on the outcome of fresh embryo transfer in IVF/ICSI cycles among young women:a retrospective cohort study[J].BMC Womens Health,2024,24:230.
[13] Kuang Y,Chen Q,Fu Y,et al.Medroxyprogesterone acetate is an effective oral alternative for preventing premature luteinizing hormone surges in women undergoing controlled ovarian hyperstimulation for in vitro fertilization[J].Fertil Steril,2015,104:62-70.e3.
[14] Xi Q,Tao Y,Qiu M,et al.Comparison between PPOS and GnRHa-long protocol in clinical outcome with the first IVF/ICSI cycle:a randomized clinical trial[J].Clin Epidemiol,2020,12:261-272.
[15] Lin G,Zhong X,Li S,et al.The clinical value of progestin-primed ovarian stimulation protocol for women with diminished ovarian reserve undergoing IVF/ICSI:a systematic review and meta-analysis[J].Front Endocrinol (Lausanne),2023,14:1232935.
[16] Mahajan S,More A,Dutta S,et al.Implications of progestin-primed ovarian stimulation (PPOS) in a patient with diminished ovarian reserve (DOR) and its in vitro fertilization (IVF) outcome[J].Cureus,2024,16:e54743.
[17] Guo H,Zhu Q,Gao H,et al.Metabolomics analysis of follicular fluid in ovarian endometriosis women receiving progestin-primed ovary stimulation protocol for in vitro fertilization[J].Sci Rep,2023,13:5747.
[18] Du L,Song J,Fan W,et al.Safety profiles of offspring born from early-follicular long-acting GnRH agonist protocol and daily mid-luteal GnRH agonist protocol:a retrospective study[J].BMC Pregnancy Childbirth,2024,24:393.
[19] Li D,Hu Z,Chen Q,et al.Neonatal outcomes and congenital malformations in children born after progestin-primed ovarian stimulation protocol[J].Front Endocrinol (Lausanne),2022,13:965863.
[20] Du M,Zhang J,Ren B,et al.Comparison of the neonatal outcomes of progestin-primed ovarian stimulation and flexible GnRH antagonist protocols:a propensity score–matched cohort study[J].Front Endocrinol (Lausanne),2023,14:1156620.
基本信息:
中图分类号:R714.8
引用信息:
[1]文艳飞,谭美玲,李云,等.卵泡期长方案在卵巢储备功能减退人群中的IVF/ICSI治疗效果研究[J].生殖医学杂志,2026,35(03):334-340.
2025-08-04
2025
2026-02-06
2026
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2026-03-15
2026-03-15