在拮抗剂方案中同时启动枸橼酸氯米芬和促性腺激素对体外受精周期累积活产、新鲜周期活产及刺激成本的影响。
Effect of simultaneously started clomiphene citrate and gonadotropins in antagonist regimes, on cumulative live births, fresh-cycle live births and cost of stimulation in IVF cycles.
作者信息
Satwik Ruma, Kochhar Mohinder
机构信息
Centre of IVF and Human Reproduction, Institute of Obstetrics and Gynaecology, Sir Gangaram Hospital, New Delhi, India.
出版信息
J Obstet Gynaecol Res. 2018 Jun;44(6):1107-1117. doi: 10.1111/jog.13624. Epub 2018 Apr 11.
AIM
The aim of the study was to compare simultaneously started clomiphene citrate (CC) and gonadotropins (Gn) with gonadotropins alone in conventional antagonist regimes with respect to fresh-cycle live births, cumulative live births and cost of ovarian stimulation per started cycle.
METHODS
This was a single-center prospective cohort study conducted over 1 year. Women undergoing autologous in vitro fertilization (IVF) treatment in antagonist protocols and who consented to participate in the study were divided into two cohorts. The CC cohort (n = 86) received 50 mg CC for 5 days and individualized Gn daily until the hCG trigger, both starting from day 2 and antagonist daily from day 8 of menstrual cycle. The Gn-only cohort (n = 349) received individualized Gn from day 2 and the antagonist from day 7 of menstrual cycle. IVF outcomes and cost of stimulation were compared between two cohorts across expected ovarian response categories.
RESULTS
The CC cohort used a mean lower dose of Gn (1741.38 ± 604.46 vs 1980.54 ± 686.42; MD = -239.16; 95%CI = -348.03 to -189.24; P = 0.003) over fewer days (8.54 ± 1.86 vs 9.25 ± 1.97; MD =-0.71;95% CI = -1.17 to -0.25; P = 0.0026) to achieve similar retrieved oocytes, (9.19 ± 5.92 vs 9.36 ± 6.96; MD = -0.17; 95%CI -1.77 to + 1.43; P = 0.83), positive bhCG rates (40% vs 29.6%, MD = 10.4%; OR = 1.65, 95%CI = 0.95-2.86; P = 0.078) and live births in fresh cycles (32.31% vs 21.30%; MD = 11.01%; OR = 1.76; 95%CI = 0.97-3.19; P = 0.06) and cumulative live births per initiated cycle (30.23% vs 20.34%; MD = 9.89%; OR = 1.697; 95%CI = 0.99-2.88; P = 0.0501). The dose lowering achieved a 28-40% reduction in the cost of stimulation, which was most noticeable in the hyper-responder category for both hMG cycles, (Rs.11 602.3 ± 3365.9 vs 19615 ± 2677.1; MD = -8012.7; %age reduction: 40.8%; P = 0.0007) and recombinant FSH cycles (Rs. 22 459.6 ± 6255.3 vs 33 022.1 ± 9891.2; MD: -10 562; %age reduction: -32%; P = 0.0001).
CONCLUSION
CC started simultaneously with Gn in antagonist regimes helps lower the cost of stimulation without affecting IVF outcomes.
目的
本研究旨在比较在常规拮抗剂方案中，同时起始使用枸橼酸氯米芬（CC）和促性腺激素（Gn）与仅使用促性腺激素在新鲜周期活产、累积活产以及每个起始周期的卵巢刺激成本方面的差异。
方法
这是一项在1年内进行的单中心前瞻性队列研究。接受拮抗剂方案自体体外受精（IVF）治疗且同意参与研究的女性被分为两个队列。CC队列（n = 86）从月经周期第2天开始，每天服用50 mg CC，共5天，并从第8天开始每天个体化使用Gn直至注射人绒毛膜促性腺激素（hCG）触发排卵；拮抗剂从月经周期第8天开始每天使用。仅Gn队列（n = 349）从月经周期第2天开始使用个体化Gn，拮抗剂从第7天开始使用。比较两个队列在预期卵巢反应类别中的IVF结局和刺激成本。
结果
CC队列在较少天数（8.54 ± 1.86天 vs 9.25 ± 1.97天；MD = -0.71；95%CI = -1.17至 -0.25；P = 0.0026）内使用了平均更低剂量的Gn（1741.38 ± 604.46 IU vs 1980.54 ± 686.42 IU；MD = -239.16；95%CI = -348.03至 -189.24；P = 0.003），以获得相似数量的回收卵母细胞（9.19 ± 5.92个 vs 9.36 ± 6.96个；MD = -0.17；95%CI = -1.77至 + 1.43；P = 0.83）、阳性血hCG率（40% vs 29.6%；MD = 10.4%；OR = 1.65；95%CI = 0.95 - 2.86；P = 0.078）以及新鲜周期活产率（32.31% vs 21.30%；MD = 11.01%；OR = 1.76；95%CI = 0.97 - 3.19；P = 0.06）和每个起始周期的累积活产率（30.23% vs 20.34%；MD = 9.89%；OR = 1.697；95%CI = 0.99 - 2.88；P = 0.0501）。剂量降低使刺激成本降低了28% - 40%，这在hMG周期和重组FSH周期的高反应者类别中最为明显，hMG周期（11 602.3 ± 3365.9卢比 vs 19615 ± 2677.1卢比；MD = -8012.7；降低百分比：40.8%；P = 0.0007）和重组FSH周期（22 459.6 ± 6255.3卢比 vs 33 022.1 ± 9891.2卢比；MD：-10 562；降低百分比：-32%；P = 0.0001）。
结论
在拮抗剂方案中与Gn同时起始使用CC有助于降低刺激成本，且不影响IVF结局。
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