Department of Obstetrics and Gynecology, Clinical Division of Obstetrics and Maternal-Fetal Medicine, Medical University of Vienna, Vienna, Austria.
Department of Obstetrics and Gynecology, Clinical Division of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
Arch Gynecol Obstet. 2019 Dec;300(6):1751-1757. doi: 10.1007/s00404-019-05359-7. Epub 2019 Nov 6.
Recent studies reported that in polycystic ovary syndrome (PCOS) patients, other stimulation agents are superior to the popular first-line regimen, clomiphene citrate (CC) for ovarian stimulation. Nonetheless, CC is still widely used since it is not clear which patients will not respond to it. Furthermore, the prognostic value of endometrium thickness at midcycle is controversial. We aimed to find factors predicting the response to CC and the prognostic value of endometrial thickness at midcycle.
We collected data retrospectively from 89 anovulatory PCOS patients who had the first stimulation with 50 mg CC. We analyzed the basal levels of AMH, testosterone, LH, LH:FSH ratio and the endometrial thickness at midcycle by univariate, followed by multivariate regression. The outcome measures were pregnancy, follicle maturation and endometrial thickness at midcycle.
Stimulation with 50 mg CC resulted in follicle maturation in 50.6% of the women and in 27.0% pregnancies. In the univariate analysis, greater endometrial thickness, lower LH and AMH levels and a lower LH:FSH ratio were associated with pregnancy (p < 0.05). In the multivariate analysis, only endometrial thickness remained predictive (p = 0.045). The endometrial thickness cutoff level of ≥ 8 mm showed a sensitivity of 87.5% (96% CI 67.6-97.3) and a specificity of 66.7% (95% CI 43.0-85.4) for prediction of pregnancy. In the multivariate analysis AMH levels 5.4 (3.4; 7.0) (ng/mL) predicted pregnancy (β = - 0.194 ± 0.092; p = 0.034) CONCLUSION: We suggest to refrain from CC as first-line regimen in patients with AMH > 7 ng/ml. Under CC treatment, the cutoff value of ≥ 8 mm endometrium thickness at midcycle is associated with a better outcome.
最近的研究表明，在多囊卵巢综合征（PCOS）患者中，其他刺激剂优于常用的一线方案——枸橼酸氯米酚（CC）用于卵巢刺激。尽管如此，由于不清楚哪些患者对 CC 没有反应，CC 仍被广泛应用。此外，中周期子宫内膜厚度的预后价值存在争议。我们旨在寻找预测 CC 反应的因素和中周期子宫内膜厚度的预后价值。
我们回顾性地收集了 89 例接受 50mg CC 首次刺激的排卵障碍性 PCOS 患者的数据。我们通过单变量分析分析了 AMH、睾酮、LH、LH/FSH 比值和中周期子宫内膜厚度的基础水平，然后进行了多变量回归。结局指标为妊娠、卵泡成熟和中周期子宫内膜厚度。
50mg CC 刺激后，50.6%的女性卵泡成熟，27.0%妊娠。在单变量分析中，较大的子宫内膜厚度、较低的 LH 和 AMH 水平以及较低的 LH/FSH 比值与妊娠相关（p<0.05）。在多变量分析中，只有子宫内膜厚度仍然具有预测性（p=0.045）。子宫内膜厚度≥8mm 的截断值显示出对妊娠的预测敏感性为 87.5%（96%CI 67.6-97.3），特异性为 66.7%（95%CI 43.0-85.4）。在多变量分析中，AMH 水平 5.4（3.4；7.0）（ng/ml）预测妊娠（β=-0.194±0.092；p=0.034）。
我们建议在 AMH>7ng/ml 的患者中避免使用 CC 作为一线方案。在 CC 治疗下，中周期子宫内膜厚度≥8mm 的截断值与更好的结局相关。
