Repromed, 180 Fullarton Road, Dulwich, 5065, South Australia.
MonashIVF Group, 21-31 Goodwood Street, Richmond, Victoria, 3121, Australia.
J Assist Reprod Genet. 2018 Jun;35(6):1047-1052. doi: 10.1007/s10815-018-1172-y. Epub 2018 Apr 10.
Mild controlled ovarian hyperstimulation (COH), combined with oocyte retrieval (OR) under local anaesthesia (LA), may provide low-impact IVF. Since a single injection of corifollitrophin alfa (CFA) provides 7 days of COH, we hypothesised that clomiphene-citrate (CC) followed by CFA may provide adequate COH response from one single FSH injection. Therefore, the aim was to assess IVF outcomes after a novel clomiphene citrate/CFA (CC/CFA) protocol, compared to women undergoing standard rFSH COH protocols (good prognosis comparative cohort:GPCC) in a 1:2 matched design.
In this pilot study of 25 patients (ANZCTR id:ACTRN12612000740897, MINIVA:Minimal_Stimulation_in_IVF), we examined the effectiveness of oral clomiphene (100 mg-days 2-6) followed by CFA in a GnRH antagonist protocol producing a single injection COH stimulation regime. All OR were conducted under LA pre-ovarian block. Cycle outcomes were compared to a matched good prognosis comparative cohort (GPCC) undergoing standard rFSH COH.
Mild stimulation was achieved with less oocytes being collected compared to the GPCC (6.4 ± 0.7 vs. 10.7 ± 0.9, p < 0.001), resulting in a reduced number of good quality embryos available for transfer/cryopreservation (3.7 ± 0.6 vs. 5.7 ± 0.5, p = 0.01). While embryo quality was similar between the two groups, endometrial thickness was significantly lower in the group receiving CC/CFA. Pregnancy rates were significantly lower in the CC/CFA cohort compared to GPCC (31.8 vs. 57.1%, p = 0.04) and 44% of CC/CFA participants required supplemental rFSH in order to achieve the hCG trigger criteria.
Sequential clomiphene CFA protocol does not appear to be an optimal regime for low impact IVF treatment as it does not provide adequate COH from a single CFA injection and results in lower fresh embryo transfer pregnancy rates and fewer embryos for cryopreservation.
轻度控制性卵巢过度刺激（COH）联合局部麻醉（LA）下卵母细胞采集（OR）可提供低冲击的体外受精（IVF）。由于单次注射促卵泡激素（CFA）可提供 7 天的 COH，我们假设克罗米芬柠檬酸（CC）后再注射 CFA，单次 FSH 注射即可获得足够的 COH 反应。因此，本研究旨在评估一种新的克罗米芬柠檬酸/CFA（CC/CFA）方案与接受标准 rFSH COH 方案的妇女（良好预后比较队列：GPCC）的 IVF 结局，采用 1:2 匹配设计。
在这项 25 例患者的试点研究中（ANZCTR id：ACTRN12612000740897，MINIVA：Minimal_Stimulation_in_IVF），我们研究了口服克罗米芬（100mg-天 2-6）后再注射 CFA 的 GnRH 拮抗剂方案在单次注射 COH 刺激方案中的有效性。所有 OR 均在 LA 卵巢前阻滞下进行。比较了 CC/CFA 组与匹配的良好预后比较队列（GPCC）接受标准 rFSH COH 的周期结局。
与 GPCC 相比，CC/CFA 组采集的卵母细胞较少（6.4±0.7 与 10.7±0.9，p<0.001），导致可供转移/冷冻保存的优质胚胎数量减少（3.7±0.6 与 5.7±0.5，p=0.01）。虽然两组胚胎质量相似，但 CC/CFA 组的子宫内膜厚度明显较低。CC/CFA 组的妊娠率明显低于 GPCC（31.8%与 57.1%，p=0.04），44%的 CC/CFA 参与者需要补充 rFSH 才能达到 hCG 触发标准。
序贯克罗米芬 CFA 方案似乎不是低冲击 IVF 治疗的最佳方案，因为它不能从单次 CFA 注射中获得足够的 COH，导致新鲜胚胎移植妊娠率降低，冷冻保存胚胎数量减少。
