{"id":90,"title":"Effects of progestin-primed ovarian stimulation protocol plus clomiphene citrate in patients with low basal LH levels: a randomized controlled trial","title_zh":"促性腺激素释放激素拮抗剂方案联合氯米芬对基础LH偏低不孕患者卵巢刺激效果：随机对照试验","url":"https://pubmed.ncbi.nlm.nih.gov/42978013","doi":"10.1186/s12958-026-01601-5","pmid":"42978013","journal":"Reprod Biol Endocrinol","kind":"paper","lang":"en","published_at":"2026-08-06T00:00:00+00:00","fetched_at":"2026-11-08T03:43:53+00:00","authors":["Hu Z","Fan Y","Zhou X","Guo H","Chai W","Chen Q","Lyu Q","Cai R","Lu X"],"primary_topic":"art-clinical","topics":[{"slug":"art-clinical","score":8.0,"hits":["clinical pregnancy","cumulative live birth","gonadotropin","infertile","ovarian stimulation"]},{"slug":"oocyte","score":6.0,"hits":["oocyte","oocytes","ovarian"]},{"slug":"repro-endo","score":6.0,"hits":["clomiphene","luteinizing hormone","menstruation"]},{"slug":"embryology-lab","score":1.0,"hits":["cryopreserved"]}],"topic_score":8.0,"preference_score":5.0,"preference_labels":["可转化到 ART 实验室的发现"],"llm_score":78.0,"final_score":83.0,"score_dims":{"novelty":72,"rigor":85,"impact":70,"relevance":95,"translation":75},"recommend_reason":"针对基础LH偏低这一易被忽视的亚组，用RCT直接检验PPOS加CC的获益假设，并给出阴性结果，对临床促排卵方案选择有直接警示价值；设计规范、终点明确，但为单中心、样本量中等，机制阐释有限。","keywords":["PPOS","氯米芬","基础LH","获卵率","随机对照试验","辅助生殖"],"selected":1,"story_id":466,"llm_provider":"deepseek","llm_model":"deepseek-flash","llm_effort":"low","source_key":"pubmed-art","source_name":"PubMed · 辅助生殖临床","source_tier":1,"mention_count":1,"has_interpretation":false,"journal_key":"rbe","journal_tier":"standard","journal_if":4.2,"is_mock":false,"summary_zh":"该前瞻性随机对照试验纳入230例基础LH<2.27 mIU/mL的不孕患者，比较hMG+甲羟孕酮（MPA）联合或不联合氯米芬（CC）的PPOS方案，主要终点为获卵率。结果显示，CC虽促进LH分泌，但联合组获卵率更低（0.71±0.22 vs 0.76±0.18，P=0.043），冻存胚胎数更少（2.89±2.43 vs 3.90±2.39），获卵数与卵母细胞利用率两组相近；累积临床妊娠率（61.05% vs 77.67%）与累积活产率（53.68% vs 66.02%）差异无统计学意义。结论提示基础LH偏低患者使用含CC的PPOS方案应谨慎。","summary":"BACKGROUND: Infertile patients with low basal luteinizing hormone (LH) levels have low oocyte retrieval rate, but whether progestin-primed ovarian stimulation (PPOS) protocol with clomiphene citrate (CC) could enhance oocyte retrieval rate in these patients remains unclear. METHODS: This prospective randomized controlled trial was performed between January 2018 and February 2021, included 230 infertile patients with low basal LH levels (LH < 2.27 mIU/mL). In study group, 115 patients received human menopausal gonadotropin (hMG) 150 or 225 IU/d + CC 50 mg/d + medroxyprogesterone acetate (MPA) 10 mg/d from the third day of menstruation. In control group, 115 patients received hMG 150 or 225 IU/d + MPA 10 mg/d from the third day of menstruation. Viable embryos were cryopreserved for later transfer. The primary outcome measure was the oocyte retrieval rate. RESULTS: CC contributed to LH secretion. The hMG+MPA+CC group showed a decreased oocyte retrieval rate (0.71 ± 0.22 vs. 0.76 ± 0.18, mean difference (MD) -0.06 (-0.11 to -0.01); P = 0.043) and a decreased number of cryopreserved embryos (2.89 ± 2.43 vs. 3.90 ± 2.39, MD -0.89 (-1.50 to -0.28); FDR-P = 0.035). Two groups had similar number of retrieved oocytes (8.83 ± 5.41 vs. 10.69 ± 5.85, MD -0.99 (-2.27 to 0.29); FDR-P = 0.213) and oocyte utilization rate (0.40 ± 0.25 vs. 0.46 ± 0.24, MD -0.07 (-0.14 to -0.01); FDR-P = 0.084). Two groups had comparable cumulative clinical pregnancy rates (61.05% vs. 77.67%, hazard ratio (HR) 0.74 (0.53 to 1.06); P = 0.101; FDR-P = 0.214) and cumulative live birth rates (53.68% vs. 66.02%, HR 0.77 (0.53 to 1.13); P = 0.183; FDR-P = 0.214). CONCLUSIONS: CC contributed to LH secretion, but PPOS protocol with CC resulted in a lower oocyte retrieval rate in patients with low basal LH levels. PPOS protocol with CC should be used cautiously in these patients. TRIAL REGISTRATION: ChiCTR number: ChiCTR1800014440. URL: https://www.chictr.org.cn/showproj.html?proj=24573. Date of registration: 2018/01/13. Date of enrollment of the first subject: 2018/1/17.","interpretation_basis":null,"fulltext_status":null,"interpretation":null,"fulltext":{"available":false,"status":null,"reason":"尚未抓取全文（未入选、分数未达阈值，或还没跑 fulltext 步骤）","pmcid":null,"license":null,"chars":0,"source":null,"fetched_at":null}}