Gupta Shruti, Satwik Ruma, Majumdar Abha, Mittal Shweta, Tiwari Neeti
Centre for IVF and Reproductive Medicine, Sir Ganga Ram Hospital, New Delhi, India.
J Hum Reprod Sci. 2015 Jul-Sep;8(3):142-5. doi: 10.4103/0974-1208.165151.
This study was conducted to compare an extended clomiphene-based ovarian stimulation regimen with the conventional antagonist protocol in donor-recipient cycles.
A total of 170 (N) donors were stimulated between January 2013 and December 2013. Conventional antagonist protocol (group I) was employed in (n1 = 31) cycles, and clomiphene was used in (n2 = 139) donor cycles (group II). 50 mg clomiphene was given simultaneously with gonadotropins from day 2 of the cycle until the day of trigger. The analysis was performed retrospectively for oocytes retrieved, fertilization rates, cycle cancelation, blastocyst formation, and pregnancy rates. The dosages, cost, and terminal E2 (estradiol) were also compared between the two groups.
The donor age groups were comparable in both the groups. There were no unsuccessful egg retrievals with clomiphene. The pregnancy rate (positive beta human chorionic gonadotropin) was significantly higher in the clomiphene group (odds ratio: 2.453; P = 0.02). Similarly, fertilization rate was significantly higher in the clomiphene group (59.5/50.5, P = 0.04). Eggs retrieved were similar in both groups, but the terminal E2 was significantly higher in the clomiphene group (P = 0.001). Average gonadotropin used was also significantly lower in clomiphene group (P < 0.001).
Clomiphene can effectively prevent luteinizing hormone surge and limit the dose of gonadotropins thus bringing down the costs and its negative impact on the endometrium and oocyte quality.
本研究旨在比较在供体-受体周期中，基于克罗米芬的延长卵巢刺激方案与传统拮抗剂方案。
2013年1月至2013年12月期间，共对170名供体进行了刺激。在31个周期中采用传统拮抗剂方案（第一组），在139个供体周期中使用了克罗米芬（第二组）。从周期第2天开始，直至扳机日，每天同时给予50mg克罗米芬和促性腺激素。对获取的卵母细胞、受精率、周期取消率、囊胚形成率和妊娠率进行回顾性分析。还比较了两组之间的药物剂量、成本和末次雌二醇（E2）水平。
两组的供体年龄组具有可比性。使用克罗米芬时，没有取卵失败的情况。克罗米芬组的妊娠率（β人绒毛膜促性腺激素阳性）显著更高（优势比：2.453；P = 0.02）。同样，克罗米芬组的受精率也显著更高（59.5/50.5，P = 0.04）。两组获取的卵母细胞数量相似，但克罗米芬组的末次E2水平显著更高（P = 0.001）。克罗米芬组使用的促性腺激素平均剂量也显著更低（P < 0.001）。
克罗米芬可有效预防促黄体生成素峰，并限制促性腺激素的剂量，从而降低成本及其对子宫内膜和卵母细胞质量的负面影响。
