FSH administration at 12-hour intervals for the first 2 days, combined with mandatory GnRH-agonist trigger and blastocyst vitrification in women (<80Kg) with high AMH levels, results in higher cumulative live birth rates and is safer.

IF 2.1 4区 医学 Q2 OBSTETRICS & GYNECOLOGY
Human Fertility Pub Date : 2023-12-01 Epub Date: 2023-01-16 DOI:10.1080/14647273.2023.2164870
Richard Fleming, Mariano Mascarenhas, Frances Roebuck, Patricia Ambrose, Clare Noble, Ann Henderson, Nicole Gibson, Marco Gaudoin
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引用次数: 0

Abstract

We aimed to determine if a programme change to 12 hourly injections of FSH (150 IU per injection) for the first 2 days of stimulation in women with high ovarian reserve (AMH ≥ 30 pmol/L), followed by 24 hourly injections, would elicit increased earlier follicular recruitment, higher egg yields and blastocyst embryos for cryopreservation, leading to potential higher cumulative pregnancy rates, than conventional daily injections throughout. For safety reasons, the approach required mandatory cryopreservation of all blastocysts (mFET group; n = 74), after ovulation trigger with GnRH-agonist, in GnRH-antagonist controlled cycles. The 'Comparator group' (n = 91) comprised women with the same high AMH levels treated with the same base dose of FSH, with the aim of fresh blastocyst transfer and cryopreservation of supernumerary embryos, treated over the preceding 2 years. There was no difference in age, AMH, weight or BMI between the groups. The mFET group achieved higher egg (17.7 versus 11.7; p < 0.001) and embryo (10.9 versus 7.2; p < 0.001) yields and fewer cases with sub-optimal embryo yields (7% versus 22%; p = 0.018). The cumulative live birth rate was superior in the mFET group (73% versus 43%), as was the safety profile, and negligible rate of treatment plan modification.

对 AMH 水平较高的女性(体重小于 80 千克),在最初 2 天内每隔 12 小时给予 FSH,同时强制使用 GnRH 激动剂触发和囊胚玻璃化,可获得更高的累积活产率,而且更安全。
我们的目的是确定,与传统的每日注射相比,在高卵巢储备妇女(AMH ≥ 30 pmol/L)的前 2 天,改为每小时注射 12 次 FSH(每次注射 150 IU),然后每小时注射 24 次,是否能更早地募集卵泡、获得更高的卵子产量和用于冷冻保存的囊胚,从而提高潜在的累积妊娠率。出于安全考虑,该方法要求在 GnRH-拮抗剂控制的周期中,使用 GnRH-拮抗剂触发排卵后,必须冷冻保存所有囊胚(mFET 组;n = 74)。对比组"(n = 91)由具有相同高 AMH 水平的女性组成,使用相同基础剂量的 FSH 进行治疗,目的是移植新鲜囊胚并冷冻保存编外胚胎,这些女性在过去两年中接受过治疗。两组患者的年龄、AMH、体重或体重指数均无差异。mFET 组获得的卵子较多(17.7 对 11.7;p p = 0.018)。mFET 组的累积活产率更高(73% 对 43%),安全性也更高,治疗方案的修改率也可忽略不计。
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来源期刊
Human Fertility
Human Fertility OBSTETRICS & GYNECOLOGY-REPRODUCTIVE BIOLOGY
CiteScore
3.30
自引率
5.30%
发文量
50
期刊介绍: Human Fertility is a leading international, multidisciplinary journal dedicated to furthering research and promoting good practice in the areas of human fertility and infertility. Topics included span the range from molecular medicine to healthcare delivery, and contributions are welcomed from professionals and academics from the spectrum of disciplines concerned with human fertility. It is published on behalf of the British Fertility Society. The journal also provides a forum for the publication of peer-reviewed articles arising out of the activities of the Association of Biomedical Andrologists, the Association of Clinical Embryologists, the Association of Irish Clinical Embryologists, the British Andrology Society, the British Infertility Counselling Association, the Irish Fertility Society and the Royal College of Nursing Fertility Nurses Group. All submissions are welcome. Articles considered include original papers, reviews, policy statements, commentaries, debates, correspondence, and reports of sessions at meetings. The journal also publishes refereed abstracts from the meetings of the constituent organizations.
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