Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA.
The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical Center, New York, NY, USA -
Minerva Obstet Gynecol. 2022 Feb;74(1):75-82. doi: 10.23736/S2724-606X.21.04837-5. Epub 2021 Jun 28.
The aim of this paper was to determine the optimal follicle size at trigger in clomiphene citrate-based in vitro fertilization (IVF) protocols.
This is a retrospective cohort study performed in at a single academic institution that included first IVF cycles with clomiphene citrate-based protocols at our center between 01/01/2013 and 03/31/2019. Patients were dichotomized by whether they had ≥2 follicles >20 mm on trigger day. Group A consisted of patients with <2 follicles >20 mm on trigger day and Group B consisted of patients with ≥2 follicles >20 mm on trigger day. The primary outcome was the number of mature oocytes retrieved. Secondary outcomes included pregnancy and live birth rates.
A total of 635 patients were included: (Group A=399 patients and Group B=236 patients). The median (IQR) diameter of the largest follicle was 20.0 mm (19.0-21.0) in Group A and 22.7 mm (21.8-24.0) in Group B (P<0.001). Among the entire cohort, mean number of oocytes retrieved was significantly higher in Group B (9.9±6.5; RR 1.08 [95% CI 1.03-1.14]) compared to Group A (9.2±6.3). In a subgroup analysis of patients in the upper quartile for age (≥41.7 years), Group B had significantly more oocytes retrieved (8.1±5.9 vs. 6.7±4.5; RR 1.23 (95% CI 1.10-1.38]), more mature oocytes retrieved (6.0±4.0 vs. 5.2±3.4; RR 1.16 [95% CI 1.02-1.33]), and more zygotes (4.7±3.5 vs. 3.6±2.8; RR 1.32 [95% CI 1.13-1.55]). In the secondary analysis, pregnancy and live birth rates after fresh transfer were similar between groups.
In clomiphene citrate-based IVF protocols, administering the ovulatory trigger at larger follicle sizes yielded more total oocytes retrieved without a significant difference in mature oocyte number. In older patients, larger follicle sizes at trigger yielded more mature oocytes and zygotes per retrieval. Based on these results, in older patients it may be advantageous to administer the ovulatory trigger in clomiphene-based IVF cycles when two or more follicles measures >20 mm. However, this benefit was not observed when assessed among all ages combined.
本研究旨在确定枸橼酸氯米酚为基础的体外受精（IVF）方案中触发时的最佳卵泡大小。
这是一项在单中心进行的回顾性队列研究，纳入了 2013 年 1 月 1 日至 2019 年 3 月 31 日期间在我院接受枸橼酸氯米酚为基础的 IVF 方案的首次 IVF 周期。根据触发日是否有≥2 个>20mm 的卵泡，将患者分为两组。A 组的触发日有<2 个>20mm 的卵泡，B 组的触发日有≥2 个>20mm 的卵泡。主要结局是成熟卵母细胞的数量。次要结局包括妊娠率和活产率。
共纳入 635 例患者：（A 组=399 例，B 组=236 例）。A 组最大卵泡的直径中位数（IQR）为 20.0mm（19.0-21.0），B 组为 22.7mm（21.8-24.0）（P<0.001）。在整个队列中，B 组的平均取卵数明显高于 A 组（9.9±6.5；RR 1.08 [95% CI 1.03-1.14]）。在年龄处于上四分位数（≥41.7 岁）的患者亚组分析中，B 组的取卵数明显更多（8.1±5.9 比 6.7±4.5；RR 1.23（95% CI 1.10-1.38）），成熟卵母细胞数更多（6.0±4.0 比 5.2±3.4；RR 1.16（95% CI 1.02-1.33）），受精卵数更多（4.7±3.5 比 3.6±2.8；RR 1.32（95% CI 1.13-1.55））。在二次分析中，新鲜移植后两组的妊娠率和活产率相似。
在枸橼酸氯米酚为基础的 IVF 方案中，在较大卵泡大小时给予排卵诱导剂可获得更多的总卵母细胞，而成熟卵母细胞数量无显著差异。在年龄较大的患者中，触发时较大的卵泡大小可获得更多的成熟卵母细胞和每个取卵周期的受精卵。基于这些结果，在年龄较大的患者中，在两个或更多卵泡大小>20mm 时，在枸橼酸氯米酚为基础的 IVF 周期中给予排卵诱导剂可能是有利的。然而，在综合所有年龄组进行评估时，并未观察到这种益处。
