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Abstract
Objective
To explore the effect of progestin-primed ovarian stimulation protocol (PPOS) on mural granulosa cells (GCs) apoptosis and hormonal profiles in follicular fluid (FF) and efficacy over GnRH antagonist (GnRH-A) protocols.
Methods
We performed a prospective cohort study from June through August 2017 at a tertiary teaching hospital. 63 Patients meeting our criteria were recruited in this prospective study voluntarily and stratified to PPOS or GnRH-A group randomly. Mural GCs and FF were collected during oocyte retrieval. Apoptosis of GCs was assessed using the Annexin V-affinity assay by flow cytometry and hormonal profiles in FF were measured using electrochemiluminescence.
Results
A total of 63 women were assessed for eligibility, with 25 cases in PPOS group and 38 in GnRH-A group. Difference of early stage apoptosis rate, late stage apoptosis rate, and total apoptosis rate did not reach statistical significance between groups. Meanwhile, concentrations of hormones in FF were comparable in two groups. No statistically significant differences were observed in number of oocytes retrieved, mature oocyte rate, fertilization rate, and top-quality embryos rate. No patients experienced premature LH surge in both groups during the study.
Conclusion
Compared to GnRH antagonist protocol, PPOS had comparable laboratory outcomes, GCs apoptosis rate and hormonal profiles in FF. PPOS is an effective and safe alternative option to provide controlled ovarian hyperstimulation (COH).
目的:探讨孕激素介导的卵巢刺激方案(PPOS)对颗粒细胞(GCs)凋亡和卵泡液(FF）激素的影响, 以及与GnRH拮抗剂(GnRH- a)方案的疗效
方法:我们从2017年6月到8月在教学医院进行了一项前瞻性队列研究。本前瞻性研究招募63例, 自愿加入且符合我们标准的患者, 随机分为PPOS组或GnRH-a组。提取卵母细胞时收集GCs和FF。流式细胞仪Annexin V亲和法检测GCs的凋亡, 电化学发光法检测FF的激素谱。
结果:共有63名女性被评估为合格, 其中PPOS组25例, GnRHA组38例。各组间早期凋亡率、晚期凋亡率、总凋亡率差异无统计学意义。同时, 两组FF的激素浓度具有可比性。卵母细胞回收数、成熟卵母细胞率、受精率、优质胚率差异无统计学意义。在研究期间, 两组患者均未出现过早的LH峰值。
结论:与GnRH拮抗剂相比, PPOS有类似的实验室结果, 如GCs凋亡率和FF的激素水平。PPOS是一种有效且安全的控制卵巢过度刺激(COH)的替代选择。
Acknowledgments
The authors are grateful to the contribution of the clinical, paramedical and laboratory team of the Reproductive Medicine Center of the Sixth Affiliated Hospital of Sun Yat-sen University.
Disclosure statement
The authors declare that there is no conflict of interest. The authors state that the views expressed in the submitted article are their own and not an official position of the institution or funder.