Effect of clomiphene citrate with different dosages on the endometrium and pregnancy outcome in patients with diminished ovarian reserve during minimal stimulation IVF/ICSI-ET
10.3760/cma.j.cn101441-20211203-00536
- VernacularTitle:不同剂量克罗米芬在微刺激方案助孕治疗中对卵巢功能减退患者子宫内膜及妊娠结局等因素的影响分析
- Author:
Chun YUAN
1
;
Jing WANG
1
;
Chunyan JIANG
1
;
Xiang MA
1
;
Feiyang DIAO
1
;
Yanqiu HU
1
;
Jiayin LIU
1
;
Yan GAO
1
Author Information
1. 南京医科大学第一附属医院生殖医学中心，南京 210029
- Publication Type:Journal Article
- Keywords:
Clomiphene citrate;
Reproductive technology, assisted;
Diminished ovarian reserve;
Minimal stimulation;
Pregnancy outcome
- From:
Chinese Journal of Reproduction and Contraception
2023;43(4):357-363
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the effect of clomiphene citrate (CC) with different dosages on the endometrial factor, number of oocytes retrieved, pregnancy outcomes and other factors in diminished ovarian reserve (DOR) patients with minimal stimulation/natural protocol.Methods:This was a retrospective cohort study. The patients who underwent minimal stimulation protocol of in vitro fertilization/intracytoplasmic sperm injection and embryo transfer (IVF/ICSI-ET) were divided into 4 groups. Group A: the patients had CC 50 mg/d from the third day of menstruation to the trigger day (1 457 cycles); group B: the patients had 50 mg/d from the third day of menstruation for 3 d (1 533 cycles); group C: the patients had CC 25 mg/d from the third day of menstruation to the trigger day (345 cycles); group D: the patients had CC 25 mg/d for 3 d (319 cycles). The general data, clinical results, pregnancy and delivery outcomes were compared between group A and group B, as well as group C and group D. Results:In the treatment of IVF/ICSI, the dosage of gonadotropin (Gn) used, number of dominant follicles, estradiol level, luteinizing hormone level, progesterone level, number of oocytes retrieved, rate of oocytes retrieved, number of fertilizations, number of transplantable embryos and whole embryo freezing rate in patients of group A were significantly higher than those in group B (all P<0.05). The endometrial thickness [7.10 (5.40,8.65) mm] and the ratio of endometrial type (A/A-B) on trigger day [70.70% (888/1 256)] of group B were significantly better than those of group A [6.00 (4.70,8.00) mm, P<0.001; 63.62% (649/1 020), P<0.001], and the fresh embryo transfer rate of group B was significantly higher than that of group A [20.00% (259/1 295) vs. 42.94% (584/1 360), P<0.001]. There were no statistical differences in the number of high-quality embryos and the rate of no embryo transfer between the two groups (both P>0.05). In group C and group D, the Gn used dosage, the number of dominant follicles, the estradiol level on trigger day, number of oocytes retrieved, embryos/cycles were significantly increased (all P<0.05), the endometrial thickness on trigger day of group D [7.00 (5.40, 8.60) mm] was significantly higher than that of group C [6.10 (5.00,7.93) mm, P<0.001], but there was no statistical difference of the ratio of endometrial type (A/A-B) between the two groups ( P=0.739). In addition, the luteinizing hormone and progesterone values on the trigger day in group C were significantly higher than those in group D ( P=0.014, P=0.005), but there were no significant differences in pre-ovulation rate and all embryos frozen rate between the two groups (all P<0.05), and the rate of fresh embryo transfer in group C [26.04% (75/288)] was significantly lower than that in group D [38.80% (97/250), P<0.001]. Finally, there were no significant differences in cumulative clinical pregnancy rate and fresh/frozen embryo transfer outcome between group A and group B as well as group C and group D (all P>0.05). Conclusion:The use of low-dose and short-time CC in minimal stimulation protocol does not change the final pregnancy outcome, while saving patients' economic and time costs, so it could be an appropriate project for DOR patients.
