Purpose

To compare the effectivity of flexible-start medroxyprogesterone acetate (MPA) co-treatment ovarian stimulations (OS) with flexible-start gonadotropin-releasing hormone antagonist (GnRH-ant) co-treatment OS, in blastocyst freeze-all IVF cycles.

Method

This matched cohort study was performed at a single IVF center. Study cycles were extracted from freeze-all IVF cycles performed between February 2015 and June 2018 with cycles grouped according to the co-treatment protocol (MPA and GnRH-ant groups) used. MPA cycles were matched 1:1 using antral follicle count, female age, infertility duration, and female body mass index, with GnRH-ant cycles, resulting in 825 matched cycles. MPA or CET co-treatment was started when leading follicles reached 11–12 mm.

Results

Duration of OS was significantly longer, and total FSH dose was significantly higher in the MPA group. Numbers of mature oocytes retrieved were similar; however, the mature oocyte retrieval rate (83.8 vs. 97.1%; p < 0.001), number of blastocysts, blastocyst rate (36.4 vs. 41.4%; p < 0.001) and > 2 viable blastocyst rate were all significantly lower in the MPA group. The live birth (LB) per transfer rates (51.6 vs. 55.7%; p = 0.155) were similar; however, the LB rate per treatment was significantly lower (40.9 vs. 45.8%; p = 0.05). A linear regression included the OS co-treatment protocol (GnRH-ant; 1.4 (1.07-1.81); p = 0.013) in the final model to predict having > 2 viable blastocysts.

Conclusion

Flexible-start MPA co-treatment OS was as effective in freeze-all IVF cycles as GnRH-ant co-treatment, with similar LB per transfer rates; however, increased cycle cancellation and reduced blastocyst numbers reduced LB per treatment rates significantly.

中文翻译：

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用于卵巢刺激的醋酸甲羟孕酮与成熟卵母细胞取回和囊胚发育减少有关：一项对 825 个全冷冻 IVF 周期的匹配队列研究。

目的

比较灵活启动醋酸甲羟孕酮 (MPA) 联合治疗卵巢刺激 (OS) 与灵活启动促性腺激素释放激素拮抗剂 (GnRH-ant) 联合治疗 OS 在囊胚冷冻全 IVF 周期中的有效性。

方法

这项匹配的队列研究是在一个 IVF 中心进行的。研究周期是从 2015 年 2 月至 2018 年 6 月期间进行的冷冻所有 IVF 周期中提取的，周期根据所使用的联合治疗方案（MPA 和 GnRH-ant 组）进行分组。MPA 周期使用窦卵泡计数、女性年龄、不孕持续时间和女性体重指数以 1:1 的比例与 GnRH-ant 周期匹配，从而产生 825 个匹配周期。当前导卵泡达到 11-12 mm 时开始 MPA 或 CET 联合治疗。

结果

MPA 组的 OS 持续时间显着更长，FSH 总剂量显着更高。取回的成熟卵母细胞数量相似；然而，MPA 组的成熟卵母细胞回收率（83.8 对 97.1%；p < 0.001）、囊胚数量、囊胚率（36.4 对 41.4%；p < 0.001）和 > 2 个存活囊胚率均显着降低. 每次转移的活产 (LB) 率（51.6 与 55.7%；p = 0.155）相似；然而，每次治疗的 LB 率明显较低（40.9 对 45.8%；p = 0.05）。线性回归包括最终模型中的 OS 联合治疗方案（GnRH-ant；1.4 (1.07-1.81)；p = 0.013），以预测具有 > 2 个可行囊胚。

结论

灵活启动 MPA 联合治疗 OS 在冷冻所有 IVF 周期中与 GnRH-ant 联合治疗一样有效，每次转移率的 LB 相似；然而，周期取消的增加和囊胚数量的减少显着降低了每次治疗的 LB 率。