International Journal of Reproductive BioMedicine
International Journal of Reproductive BioMedicine
IJRM
Medical Sciences
http://ijrm.ir
1
admin
2476-4108
2476-3772
10.29252/ijrm
en
jalali
1403
12
1
gregorian
2025
3
1
23
3
online
1
fulltext
en
ارزیابی پروتکلهای آگونیست و آنتاگونیست هورمون آزادکننده گنادوتروپین بر پیامدهای بارداری در گروههای POSEIDON-4 3: یک کارآزمایی تصادفیسازی و کنترلشده
Evaluation of gonadotropin-releasing hormone agonist and antagonist protocols on pregnancy outcomes in POSEIDON groups 3 and 4: A randomized controlled trial
Assisted Reproductive Technologies
Original Article
Original Article
<div style="text-align: justify;"><span style="font-size:12pt"><span style="text-justify:inter-ideograph"><span style="direction:rtl"><span style="unicode-bidi:embed"><span style="font-family:"Times New Roman",serif"><b><span lang="FA" style="font-size:11.0pt"><span style="font-family:"B Mitra"">مقدمه: </span></span></b><span lang="FA" style="font-size:11.0pt"><span style="font-family:"B Mitra"">با توجه به اینکه افراد دارای ذخیره تخمدانی پایین بخش قابل توجهی از مراجعه­کنندگان به مراکز ناباروری را تشکیل می­دهند، این مطالعه به مقایسه دو پروتکل درمانی در افراد دارای ذخیره تخمدان پایین می­پردازد.</span></span></span></span></span></span></span><br>
<span style="font-size:12pt"><span style="text-justify:inter-ideograph"><span style="direction:rtl"><span style="unicode-bidi:embed"><span style="font-family:"Times New Roman",serif"><b><span lang="FA" style="font-size:11.0pt"><span style="font-family:"B Mitra"">هدف: </span></span></b><span lang="FA" style="font-size:11.0pt"><span style="font-family:"B Mitra"">هدف از این مطالعه مقایسه اثربخشی پروتکل­های آنتاگونیست </span></span><span dir="LTR" style="font-size:10.0pt">GnRH</span> <span lang="FA" style="font-size:11.0pt"><span style="font-family:"B Mitra"">و آگونیست </span></span><span dir="LTR" style="font-size:10.0pt">GnRH</span><span lang="FA" style="font-size:11.0pt"><span style="font-family:"B Mitra""> در بیماران مبتلا به ذخیره تخمدانی کاهش یافته (</span></span><span dir="LTR" style="font-size:10.0pt">DOR</span><span lang="FA" style="font-size:11.0pt"><span style="font-family:"B Mitra"">) در گروه­های</span></span> <span dir="LTR" style="font-size:10.0pt">POSEIDON 3-4</span><span lang="FA" style="font-size:11.0pt"><span style="font-family:"B Mitra""> که تحت پروتکل­های کمک­باروری قرار گرفتند.</span></span><b><span dir="LTR" style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif"></span></span></b></span></span></span></span></span><br>
<span style="font-size:12pt"><span style="text-justify:inter-ideograph"><span style="direction:rtl"><span style="unicode-bidi:embed"><span style="font-family:"Times New Roman",serif"><b><span lang="FA" style="font-size:11.0pt"><span style="font-family:"B Mitra"">مواد و روش­ ها: </span></span></b><span lang="FA" style="font-size:11.0pt"><span style="font-family:"B Mitra"">این کارآزمایی بالینی تصادفیشده بر روی 158 زن نابارور مبتلا به </span></span><span dir="LTR" style="font-size:10.0pt">DOR</span> <span lang="FA" style="font-size:11.0pt"><span style="font-family:"B Mitra"">2/1</span></span><span dir="LTR" style="font-size:10.0pt"><</span> <span lang="FA" style="font-size:11.0pt"><span style="font-family:"B Mitra""> (</span></span><span dir="LTR" style="font-size:10.0pt">AMH</span><span lang="FA" style="font-size:11.0pt"><span style="font-family:"B Mitra"">) نانوگرم در میلیلیتر یا (5 </span></span><span dir="LTR" style="font-size:10.0pt"><</span> <span dir="LTR" style="font-size:10.0pt">AFC</span><span lang="FA" style="font-size:11.0pt"><span style="font-family:"B Mitra"">) تحت </span></span><span dir="LTR" style="font-size:10.0pt">IVF/ICSI</span><span lang="FA" style="font-size:11.0pt"><span style="font-family:"B Mitra""> وارد مطالعه شدند. بیماران به طور تصادفی تحت پروتکل درمانی آنتاگونیست </span></span><span dir="LTR" style="font-size:10.0pt">GnRH</span><span lang="FA" style="font-size:11.0pt"><span style="font-family:"B Mitra""> (84 نفر) یا آگونیست طولانی </span></span><span dir="LTR" style="font-size:10.0pt">GnRH</span><span lang="FA" style="font-size:11.0pt"><span style="font-family:"B Mitra""> (74 نفر) اختصاص داده شدند. پیامدهای اولیه شامل حاملگی بالینی و پیامدهای ثانویه حاملگی شیمیایی، میزان سقط زودرس، حاملگی مداوم و میزان لانه­گزینی است.</span></span></span></span></span></span></span><br>
<span style="font-size:12pt"><span style="text-justify:inter-ideograph"><span style="direction:rtl"><span style="unicode-bidi:embed"><span style="font-family:"Times New Roman",serif"><b><span lang="FA" style="font-size:11.0pt"><span style="font-family:"B Mitra"">نتایج: </span></span></b><span lang="FA" style="font-size:11.0pt"><span style="font-family:"B Mitra"">تفاوت معنی­داری در مقادیر پایه بین گروه­ها وجود نداشت. گروه آگونیست </span></span><span dir="LTR" style="font-size:10.0pt">GnRH</span><span lang="FA" style="font-size:11.0pt"><span style="font-family:"B Mitra""> در مقایسه با گروه آنتاگونیست مدت زمان تحریک طولانی­تری (23/12 در مقابل 60/10 روز، 001/0 </span></span><span lang="FA" style="font-size:10.0pt">> </span><span dir="LTR" style="font-size:10.0pt">p</span><span lang="FA" style="font-size:11.0pt"><span style="font-family:"B Mitra"">) و دوز کل گنادوتروپین (84/4588 در مقابل 67/3225 واحد بین المللی، 001/0 </span></span><span lang="FA" style="font-size:10.0pt">> </span><span dir="LTR" style="font-size:10.0pt">p</span><span lang="FA" style="font-size:11.0pt"><span style="font-family:"B Mitra"">) داشت. نرخ حاملگی بالینی (8/%17 در مقابل 8/15%، 810/0 </span></span><span lang="FA" style="font-size:10.0pt">= </span><span dir="LTR" style="font-size:10.0pt">p</span><span lang="FA" style="font-size:11.0pt"><span style="font-family:"B Mitra"">) و نرخ تولد زنده (1/11% در مقابل 2/13%، 775/0 = </span></span><span dir="LTR" style="font-size:10.0pt">p</span><span lang="FA" style="font-size:11.0pt"><span style="font-family:"B Mitra"">) در</span></span> <span lang="FA" style="font-size:11.0pt"><span style="font-family:"B Mitra"">گروه آگونیست و آنتاگونیست بود.</span></span></span></span></span></span></span><br>
<span style="font-size:12pt"><span style="text-justify:inter-ideograph"><span style="direction:rtl"><span style="unicode-bidi:embed"><span style="font-family:"Times New Roman",serif"><b><span lang="FA" style="font-size:11.0pt"><span style="font-family:"B Mitra"">نتیجه­ گیری: </span></span></b><span lang="FA" style="font-size:11.0pt"><span style="font-family:"B Mitra"">بر اساس دادههای بهدستآمده، در بیماران مبتلا به </span></span><span dir="LTR" style="font-size:10.0pt">DOR</span><span lang="FA" style="font-size:11.0pt"><span style="font-family:"B Mitra""> گروه 3-4 </span></span><span dir="LTR" style="font-size:10.0pt">POSEIDON</span><span lang="FA" style="font-size:11.0pt"><span style="font-family:"B Mitra"">، پروتکلهای آنتاگونیست </span></span><span dir="LTR" style="font-size:10.0pt">GnRH</span><span lang="FA" style="font-size:11.0pt"><span style="font-family:"B Mitra""> و آگونیست طولانی </span></span><span dir="LTR" style="font-size:10.0pt">GnRH</span><span lang="FA" style="font-size:11.0pt"><span style="font-family:"B Mitra""> نتایج مشابهی را به دنبال داشت. پروتکل آنتاگونیست با تحریک کوتاه­تر و مصرف کمتر گنادوتروپین همراه بود. برای تأیید این نتایج و تعیین پروتکل بهینه برای این گروه بیمار، مطالعات بزرگتری مورد نیاز است.</span></span><b><span dir="LTR" style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif"></span></span></b></span></span></span></span></span></div>
<span style="font-size:11pt"><span style="line-height:normal"><span calibri="" style="font-family:"><b><span style="font-size:12.0pt"><span new="" roman="" style="font-family:" times="">Background: </span></span></b><span style="font-size:12.0pt"><span new="" roman="" style="font-family:" times="">Women with low ovarian reserve are the capable part of people who refer to infertility centers, this study compares 2 treatment protocols in cases with low ovarian reserve.</span></span></span></span></span><br>
<span style="font-size:11pt"><span style="line-height:normal"><span calibri="" style="font-family:"><b><span style="font-size:12.0pt"><span new="" roman="" style="font-family:" times="">Objective:</span></span></b><span style="font-size:12.0pt"><span new="" roman="" style="font-family:" times=""> This study aimed to compare the efficacy of gonadotropin-releasing hormone (GnRH) agonist and GnRH-antagonist protocols in women with diminished ovarian reserve (DOR) in POSEIDON groups 3-4 undergoing in assisted reproductive technology (ART).</span></span><span dir="RTL" lang="FA" style="font-size:12.0pt"><span style="font-family:"Times New Roman","serif""></span></span></span></span></span><br>
<span style="font-size:11pt"><span style="line-height:normal"><span style="text-autospace:none"><span calibri="" style="font-family:"><b><span style="font-size:12.0pt"><span new="" roman="" style="font-family:" times="">Materials and Methods:</span></span></b><span style="font-size:12.0pt"><span new="" roman="" style="font-family:" times=""> This randomized clinical trial enrolled 158 infertile women with diminished ovarian reserve undergoing ART at the Research and Clinical Center for Infertility, Yazd, Iran from January to October 2024. Women were randomly assigned to either a GnRH-antagonist (n = 84) or a long GnRH-agonist (n = 74). Primary outcomes included clinical pregnancy and secondary outcomes were chemical pregnancy, early abortion rate, ongoing pregnancy, and implantation rate.</span></span></span></span></span></span><br>
<span style="font-size:11pt"><span style="line-height:normal"><span calibri="" style="font-family:"><b><span style="font-size:12.0pt"><span new="" roman="" style="font-family:" times="">Results:</span></span></b><span style="font-size:12.0pt"><span new="" roman="" style="font-family:" times=""> No significant differences were observed in baseline values between groups. The GnRH-agonist group had a longer stimulation duration (12.23 vs. 10.60 days, p < 0.001) and a higher total gonadotropin dose (4588.84 vs. 3225.67 IU, p < 0.001) compared to the antagonist group. Clinical pregnancy rates (17.8% vs. 15.8%, p = 0.810) and live birth rates (11.1% vs. 13.2%, p = 0.775) were comparable the agonist and antagonist groups.</span></span></span></span></span><br>
<span style="font-size:11pt"><span style="line-height:normal"><span calibri="" style="font-family:"><b><span style="font-size:12.0pt"><span new="" roman="" style="font-family:" times="">Conclusion:</span></span></b><span style="font-size:12.0pt"><span new="" roman="" style="font-family:" times=""> According to acquired data</span></span><span style="font-size:12.0pt"><span new="" roman="" style="font-family:" times="">,</span></span><span style="font-size:12.0pt"><span new="" roman="" style="font-family:" times="">the GnRH-antagonist and long GnRH-agonist protocols resulted in similar ART outcomes. The antagonist protocol was associated with shorter stimulation and lower gonadotropin consumption. As a result, the antagonist protocol was found to be more cost effective. Larger studies are needed to confirm these results and determine the optimal protocol for this woman group.</span></span></span></span></span><br>
ذخیره تخمدان, تحریک تخمدان, لقاح آزمایشگاهی, روش های کمک باروری.
Ovarian reserve, Ovarian stimulation, In vitro fertilization, ART.
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http://ijrm.ir/browse.php?a_code=A-10-226-13&slc_lang=en&sid=1
Zahra
Aminimajomerd
ssn136@yahoo.com