关键词: 促性腺激素, 波塞冬标准低预后, 拮抗剂方案, 临床结局

Abstract:

Objective　To compare the effects of different doses of gonadotropin (Gn) on the clinical outcomes of the Poseidon population with low prognosis when used in an antagonist protocol, and to provide a basis for individualized medication. Methods　This study was a retrospective cohort study. A total of 195 patients who underwent assisted reproductive technology (ART) assisted pregnancy treatment in the reproductive medicine department of Xi'an Gaoxin Hospital from February 2023 to February 2024 were selected. Among them, 221 oocyte retrieval cycles of patients with low prognosis according to the Poseidon criteria and using the antagonist protocol for ovulation induction were identified. The included patients were followed up for at least one year. According to the different total doses of Gn used in the antagonist protocol, the patients were divided into the low-dose group (≤3 000 U) with 124 oocyte retrieval cycles and the high-dose group (>3 000 U) with 97 oocyte retrieval cycles. The age of the low-dose group was (36.52±2.55) years; the body mass index was (22.56±4.51) kg/m²; the duration of infertility was (3.11±1.04) years. The age of the high-dose group was (36.83±3.11) years; the body mass index was (23.60±4.25) kg/m²; the duration of infertility was (2.87±1.44) years. The baseline data were compared between the two groups [age, body mass index, duration of infertility, basal follicle-stimulating hormone (bFSH), basal estradiol (bE₂), basal progesterone (bP), basal luteinizing hormone (bLH), basal testosterone (bT), basal prolactin (bPRL), and anti-Müllerian hormone (AMH)], the outcome of ovulation induction (initial dose of Gn, number of days used by Gn, total dose of Gn, number of retrieved oocytes, number of mature oocytes, fertilization rate, and quality embryo rate), and clinical outcomes [clinical pregnancy rate, live birth rate, and incidence of ovarian hyperstimulation syndrome (OHSS)]. Independent sample t test, non-parametric test, χ² test, and Fisher's exact probability method were used for statistical analysis. Results　Comparison of baseline data between the two groups showed no statistically significant differences (all P>0.05). There was no statistically significant difference in the initial dose of Gn, fertilization rate, and quality embryo rate between the two groups (all P>0.05). The number of days used by Gn, total dose of Gn, number of retrieved oocytes, and number of mature oocytes in the high-dose group were all higher than those in the low-dose group [(11.24±2.68) d vs. (10.44±3.01) d, (3 344.13±525.74) U vs. (2 431.57±642.63) U, 3.00 (2.00, 6.00) vs. 2.00 (2.00, 5.00), 3.00 (2.00, 5.00) vs. 2.00 (2.00, 4.00)] (all P<0.05). In the low-dose group, a total of 17 oocyte retrieval cycles were not carried out for embryo transfer due to the occurrence of OHSS or poor endometrial conditions. In the high-dose group, 9 oocyte retrieval cycles were not performed for embryo transfer. There was no statistically significant difference in the clinical pregnancy rate, live birth rate, and the incidence of OHSS between the two groups (all P>0.05). Conclusions　The use of high-dose Gn can increase the number of oocytes retrieved by patients, but it has no significant effect on the clinical pregnancy rate, live birth rate, or the incidence of OHSS. Although not statistically significant, it was observed that the incidence of OHSS in the high-dose Gn group was higher, suggesting that clinicians still need to be vigilant when applying it.

Key words:

Gonadotropins, Poseidon standard low prognosis, Antagonist protocol, Clinical outcomes