大橋 麻衣

Progestin-primed ovarian stimulation法(以下PPOS法)は近年急速に広まりつつある調節卵巣刺激法であるが,臨床成績に関するデータが少なく刺激法として確立されていない。今回,2021年4月から2023年3月に当院で採卵した患者のうち,MPAを用いたPPOS法116例とGnRH antagonist法(以下antagonist法)108例の臨床成績を比較検討した。平均年齢はPPOS法で36.9±4.3歳,antagonist法で37.8±4.3歳,平均AMH値はPPOS法で3.3±3.8ng/mL,antagonist法で3.2±2.8ng/mLであった。採卵数,獲得胚盤胞数は,両群で差を認めなかったが,獲得良好胚盤胞数は,PPOS法で1.2±1.9個,antagonist法で0.7±1.1個とPPOS法で有意に多かった(p=0.02)。採卵後初回胚移植での臨床的妊娠率は,PPOS法で40.7%(37/91),antagonist法で26.1%(23/88)とPPOS法で有意に高かった(p=0.04)。AMH値で層化した解析では,獲得良好胚盤胞数は低・中反応群では有意差はなかったが,高反応群ではPPOS法で有意に多かった。本研究では,PPOS法はantagonist法と比較し獲得良好胚盤胞数が多く妊娠成績が良好であった。(著者抄録)

Assisted reproductive technology (ART) requires transvaginal oocyte retrieval (TVOR), and ovarian bleeding after TVOR rarely occurs. We present a case of a 37-year-old woman (0-gravida) who was diagnosed with possible hemorrhagic telangiectasia (HHT) and had a history of three laparotomies for ovarian bleeding and an inclusion cyst adjacent to the right ovary after the third operation. HHT is a hereditary disease characterized by spontaneous hemorrhage of some organs, such as the nose, brain, lungs, gastrointestinal tract, and liver. She desired ART after fertility treatment and then had abdominal pain with ovarian swelling five days after TVOR. Moreover, both the right ovary and inclusion cyst were gradually swollen with hematoma. Finally, abdominal pain and the hemoglobin level deteriorated, necessitating an emergency surgery on the eighth day. We notify reproductive physicians that patients with HHT may readily develop ovarian bleeding with or without inclusion cysts after TVOR, although inclusion cysts may also be associated with late-onset bleeding.