Alberto Vaiarelli, Erika Pittana, Danilo Cimadomo, Alessandro Ruffa, Silvia Colamaria, Cindy Argento, Maddalena Giuliani, Pasquale Petrone, Gemma Fabozzi, Federica Innocenti, Marilena Taggi, Baris Ata, Laura Rienzi, Filippo Maria Ubaldi
{"title":"通过 DuoStim 和孕激素刺激卵巢（PPOS）方案的多循环方法：对接受 PGT-A 的预后不良患者来说是一种有价值的选择。","authors":"Alberto Vaiarelli, Erika Pittana, Danilo Cimadomo, Alessandro Ruffa, Silvia Colamaria, Cindy Argento, Maddalena Giuliani, Pasquale Petrone, Gemma Fabozzi, Federica Innocenti, Marilena Taggi, Baris Ata, Laura Rienzi, Filippo Maria Ubaldi","doi":"10.1007/s10815-024-03317-0","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>This study is to evaluate the effectiveness of a PPOS protocol in poor prognosis patients undergoing IVF with DuoStim and PGT-A versus the conventional protocol with GnRH antagonist.</p><p><strong>Methods: </strong>Retrospective cohort study encompassing 444 couples obtained matching one PPOS-DuoStim with two antagonist-DuoStim cycles at a private IVF center between 2020 and 2023 (average maternal age: 40 years, average cumulus-oocyte complexes collected after the first stimulation: 5). The study was powered to exclude a two-sided different euploid blastocyst rate per MII oocytes (EBR per MII) in the two groups (alpha = 0.05, power = 0.9, effect size = 0.3). All cycles involved ICSI, blastocyst stage PGT-A, and single vitrified-warmed euploid transfers. We compared all embryological and clinical outcomes within each group (first vs. second stimulations), and among the two study arms (first stimulation vs. first stimulation; second stimulations vs. second stimulation; overall). The overall EBR per MII was the primary study outcome. The cumulative-live-birth-rate per concluded cycles (CLBR) was the main secondary outcome.</p><p><strong>Results: </strong>In the second stimulations, we obtained a greater number of COCs and MIIs in both antagonist- and PPOS-DuoStim groups. No difference was observed for all embryological and clinical outcomes when comparing the two stimulations within each group. All embryological and clinical outcomes were comparable also between the two groups, including the EBR per MII. To date, 285 and 121 antagonist- and PPOS-DuoStim cycles were concluded. The CLBR was comparable between the groups: 26% vs. 29%.</p><p><strong>Conclusions: </strong>PPOS-DuoStim holds potential for being an efficient, patient-friendly, and possibly cost-effective approach that does not compromise treatment efficacy. Future investigations must explore PPOS effect on follicular recruitment, neonatal, and long-term outcomes.</p>","PeriodicalId":15246,"journal":{"name":"Journal of Assisted Reproduction and Genetics","volume":" ","pages":""},"PeriodicalIF":3.2000,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"A multicycle approach through DuoStim with a progestin-primed ovarian stimulation (PPOS) protocol: a valuable option in poor prognosis patients undergoing PGT-A.\",\"authors\":\"Alberto Vaiarelli, Erika Pittana, Danilo Cimadomo, Alessandro Ruffa, Silvia Colamaria, Cindy Argento, Maddalena Giuliani, Pasquale Petrone, Gemma Fabozzi, Federica Innocenti, Marilena Taggi, Baris Ata, Laura Rienzi, Filippo Maria Ubaldi\",\"doi\":\"10.1007/s10815-024-03317-0\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>This study is to evaluate the effectiveness of a PPOS protocol in poor prognosis patients undergoing IVF with DuoStim and PGT-A versus the conventional protocol with GnRH antagonist.</p><p><strong>Methods: </strong>Retrospective cohort study encompassing 444 couples obtained matching one PPOS-DuoStim with two antagonist-DuoStim cycles at a private IVF center between 2020 and 2023 (average maternal age: 40 years, average cumulus-oocyte complexes collected after the first stimulation: 5). The study was powered to exclude a two-sided different euploid blastocyst rate per MII oocytes (EBR per MII) in the two groups (alpha = 0.05, power = 0.9, effect size = 0.3). All cycles involved ICSI, blastocyst stage PGT-A, and single vitrified-warmed euploid transfers. We compared all embryological and clinical outcomes within each group (first vs. second stimulations), and among the two study arms (first stimulation vs. first stimulation; second stimulations vs. second stimulation; overall). The overall EBR per MII was the primary study outcome. The cumulative-live-birth-rate per concluded cycles (CLBR) was the main secondary outcome.</p><p><strong>Results: </strong>In the second stimulations, we obtained a greater number of COCs and MIIs in both antagonist- and PPOS-DuoStim groups. No difference was observed for all embryological and clinical outcomes when comparing the two stimulations within each group. All embryological and clinical outcomes were comparable also between the two groups, including the EBR per MII. To date, 285 and 121 antagonist- and PPOS-DuoStim cycles were concluded. The CLBR was comparable between the groups: 26% vs. 29%.</p><p><strong>Conclusions: </strong>PPOS-DuoStim holds potential for being an efficient, patient-friendly, and possibly cost-effective approach that does not compromise treatment efficacy. 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引用次数: 0
摘要
目的：本研究旨在评估PPOS方案对接受DuoStim和PGT-A试管婴儿治疗的预后不良患者的疗效，与使用GnRH拮抗剂的传统方案进行比较：回顾性队列研究：2020年至2023年期间，在一家私立试管婴儿中心，444对夫妇获得了一个PPOS-DuoStim与两个拮抗剂-DuoStim周期的匹配（平均母体年龄：40岁，第一次刺激后收集的平均精母细胞复合体：5个）：5).该研究的功率排除了两组每 MII 卵母细胞优倍囊胚率（EBR per MII）的双侧差异（α = 0.05，功率 = 0.9，效应大小 = 0.3）。所有周期均采用卵胞浆内单精子显微注射、囊胚期 PGT-A 和单次玻璃化温育优胚移植。我们比较了各组（第一次刺激与第二次刺激）以及两个研究臂（第一次刺激与第一次刺激；第二次刺激与第二次刺激；总体）的所有胚胎学和临床结果。每个 MII 的总体 EBR 是主要的研究结果。每完成一个周期的累积活产率（CLBR）是主要的次要结果：结果：在第二次刺激中，拮抗剂组和 PPOS-DuoStim 组都获得了更多的 COC 和 MII。在各组内比较两次刺激的所有胚胎学和临床结果，未观察到差异。两组的所有胚胎学和临床结果（包括每个 MII 的 EBR）也具有可比性。迄今为止，拮抗剂和 PPOS-DuoStim 两个周期的结果分别为 285 和 121 个。两组的CLBR相当：26% 对 29%：PPOS-DuoStim有望成为一种高效、方便患者且可能具有成本效益的方法，而且不会影响治疗效果。未来的研究必须探索 PPOS 对卵泡募集、新生儿和长期结果的影响。
A multicycle approach through DuoStim with a progestin-primed ovarian stimulation (PPOS) protocol: a valuable option in poor prognosis patients undergoing PGT-A.
Purpose: This study is to evaluate the effectiveness of a PPOS protocol in poor prognosis patients undergoing IVF with DuoStim and PGT-A versus the conventional protocol with GnRH antagonist.
Methods: Retrospective cohort study encompassing 444 couples obtained matching one PPOS-DuoStim with two antagonist-DuoStim cycles at a private IVF center between 2020 and 2023 (average maternal age: 40 years, average cumulus-oocyte complexes collected after the first stimulation: 5). The study was powered to exclude a two-sided different euploid blastocyst rate per MII oocytes (EBR per MII) in the two groups (alpha = 0.05, power = 0.9, effect size = 0.3). All cycles involved ICSI, blastocyst stage PGT-A, and single vitrified-warmed euploid transfers. We compared all embryological and clinical outcomes within each group (first vs. second stimulations), and among the two study arms (first stimulation vs. first stimulation; second stimulations vs. second stimulation; overall). The overall EBR per MII was the primary study outcome. The cumulative-live-birth-rate per concluded cycles (CLBR) was the main secondary outcome.
Results: In the second stimulations, we obtained a greater number of COCs and MIIs in both antagonist- and PPOS-DuoStim groups. No difference was observed for all embryological and clinical outcomes when comparing the two stimulations within each group. All embryological and clinical outcomes were comparable also between the two groups, including the EBR per MII. To date, 285 and 121 antagonist- and PPOS-DuoStim cycles were concluded. The CLBR was comparable between the groups: 26% vs. 29%.
Conclusions: PPOS-DuoStim holds potential for being an efficient, patient-friendly, and possibly cost-effective approach that does not compromise treatment efficacy. Future investigations must explore PPOS effect on follicular recruitment, neonatal, and long-term outcomes.
期刊介绍：
The Journal of Assisted Reproduction and Genetics publishes cellular, molecular, genetic, and epigenetic discoveries advancing our understanding of the biology and underlying mechanisms from gametogenesis to offspring health. Special emphasis is placed on the practice and evolution of assisted reproduction technologies (ARTs) with reference to the diagnosis and management of diseases affecting fertility. Our goal is to educate our readership in the translation of basic and clinical discoveries made from human or relevant animal models to the safe and efficacious practice of human ARTs. The scientific rigor and ethical standards embraced by the JARG editorial team ensures a broad international base of expertise guiding the marriage of contemporary clinical research paradigms with basic science discovery. JARG publishes original papers, minireviews, case reports, and opinion pieces often combined into special topic issues that will educate clinicians and scientists with interests in the mechanisms of human development that bear on the treatment of infertility and emerging innovations in human ARTs. The guiding principles of male and female reproductive health impacting pre- and post-conceptional viability and developmental potential are emphasized within the purview of human reproductive health in current and future generations of our species.
The journal is published in cooperation with the American Society for Reproductive Medicine, an organization of more than 8,000 physicians, researchers, nurses, technicians and other professionals dedicated to advancing knowledge and expertise in reproductive biology.
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