不同剂量克罗米芬在微刺激方案助孕治疗中对卵巢功能减退患者子宫内膜及妊娠结局等因素的影响分析  

Effect of clomiphene citrate with different dosages on the endometrium and pregnancy outcome in patients with diminished ovarian reserve during minimal stimulation IVF/ICSI-ET

作　　者：袁纯[1] 王菁[1] 蒋春艳[1] 马翔[1] 刁飞扬[1] 胡艳秋[1] 刘嘉茵[1] 高彦[1] Yuan Chun;Wang Jing;Jiang Chunyan;Ma Xiang;Diao Feiyang;Hu Yanqiu;Liu Jiayin;Gao Yan(Center of Reproductive Medicine,the First Affiliated Hospital,Nanjing Medical University,Nanjing210029,China)

机构地区：[1]南京医科大学第一附属医院生殖医学中心,南京210029

出　　处：《中华生殖与避孕杂志》2023年第4期357-363,共7页Chinese Journal of Reproduction and Contraception

基　　金：江苏省自然科学青年基金(BK20191076);国家自然科学青年基金(81901449)。

摘　　要：目的探讨不同剂量的克罗米芬(clomiphene citrate,CC)对卵巢功能减退(diminished ovarian reserve,DOR)患者微刺激方案助孕治疗中子宫内膜因素、获卵数、助孕结局以及其他因素的影响。方法回顾性队列研究分析2018年1月至2020年1月期间于南京医科大学第一附属医院生殖医学中心行微刺激方案体外受精/卵胞质内单精子注射-胚胎移植(in vitro fertilization/intracytoplasmic sperm injection and embryo transfer,IVF/ICSI-ET)助孕周期的临床资料,根据不同CC剂量方案分为4组:A组从月经第3天起CC 50 mg/d至扳机日,共1457个周期;B组从月经第3天起CC 50 mg/d仅使用3 d,共1533个周期;C组从月经第3天起CC 25 mg/d至扳机日,共345个周期;D组从月经第3天起CC 25 mg/d仅使用3 d,共319个周期,两两比较并分析4组患者的临床数据。结果A组患者所用的促性腺激素(gonadotropin,Gn)使用总量、Gn使用时间、优势卵泡数、扳机日激素水平、获卵数、获卵率、受精数、可移植胚胎数以及全胚冷冻率均显著高于B组(均P<0.05)。B组的扳机日内膜厚度[7.10(5.40,8.65)mm]及A/A-B型百分比[70.70%(888/1256)]显著优于A组[6.00(4.70,8.00)mm,P<0.001;63.62%(649/1020),P<0.001],其鲜胚移植率[20.00%(259/1295)]显著高于A组[42.94%(584/1360),P<0.001],两组的移植优质胚胎数和无可移植胚胎率差异均无统计学意义(均P>0.05)。与D组比较,C组患者所用的Gn使用总量、Gn使用时间、优势卵泡数、扳机日雌二醇、获卵数、每周期受精数/可移植胚胎数均显著增加(均P<0.05),D组患者的扳机日内膜厚度[7.00(5.40,8.60)mm]显著高于C组[6.10(5.00,7.93)mm,P<0.001],但是两组间内膜A/A-B型百分比差异无统计学意义(P=0.739)。此外,C组的扳机日黄体生成素及孕酮值显著高于D组(P=0.014,P=0.005),但是两组卵子早排率、全胚冷冻率差异均无统计学意义(均P>0.05),C组鲜胚移植率[26.04%(75/288)]显著低于D组[38.80%(97/250),P<0.001]。A组和B组Objective To explore the effect of clomiphene citrate(CC)with different dosages on the endometrial factor,number of oocytes retrieved,pregnancy outcomes and other factors in diminished ovarian reserve(DOR)patients with minimal stimulation/natural protocol.Methods This was a retrospective cohort study.The patients who underwent minimal stimulation protocol of in vitro fertilization/intracytoplasmic sperm injection and embryo transfer(IVF/ICSI-ET)were divided into 4 groups.Group A:the patients had CC 50 mg/d from the third day of menstruation to the trigger day(1457 cycles);group B:the patients had 50 mg/d from the third day of menstruation for 3 d(1533 cycles);group C:the patients had CC 25 mg/d from the third day of menstruation to the trigger day(345 cycles);group D:the patients had CC 25 mg/d for 3 d(319 cycles).The general data,clinical results,pregnancy and delivery outcomes were compared between group A and group B,as well as group C and group D.Results In the treatment of IVF/ICSI,the dosage of gonadotropin(Gn)used,number of dominant follicles,estradiol level,luteinizing hormone level,progesterone level,number of oocytes retrieved,rate of oocytes retrieved,number of fertilizations,number of transplantable embryos and whole embryo freezing rate in patients of group A were significantly higher than those in group B(all P<0.05).The endometrial thickness[7.10(5.40,8.65)mm]and the ratio of endometrial type(A/A-B)on trigger day[70.70%(888/1256)]of group B were significantly better than those of group A[6.00(4.70,8.00)mm,P<0.001;63.62%(649/1020),P<0.001],and the fresh embryo transfer rate of group B was significantly higher than that of group A[20.00%(259/1295)vs.42.94%(584/1360),P<0.001].There were no statistical differences in the number of high-quality embryos and the rate of no embryo transfer between the two groups(both P>0.05).In group C and group D,the Gn used dosage,the number of dominant follicles,the estradiol level on trigger day,number of oocytes retrieved,embryos/cycles were significantly increased(al

关 键 词：克罗米芬 生殖技术 辅助 卵巢功能减退 微刺激 妊娠结局 

分 类 号：R714.8[医药卫生—妇产科学]