生殖医学杂志

目的观察以低剂量缓释达菲林长方案降调,在超排卵后期联合加用克罗米芬抑制黄体生成素(LH)峰,应用于体外受精(IVF)促排卵的临床结果与预后因素。方法排卵后7 d肌注缓释达菲林0.34 mg(0.2 ml),月经周期第3～5日开始肌注人绝经期促性腺激素(HMG)150～225 IU连续8 d后开始加用克罗米芬(CC)50 mg/d至诱发排卵日。比较CC使用前后内膜厚度、LH及临床妊娠率、种植率、流产率等。结果共纳入156例患者,新鲜周期临床妊娠率为23.9%(22/92),流产率13.6%(3/22),种植率20.5%(23/112)。冷冻周期临床妊娠率33.3%(19/57),种植率18.9%(21/111)。人绒毛膜促性腺激素(hCG)日与CC起始日相比,内膜11.3±3.1 vs 10.3±2.8 mm显著增厚(P<0.05),LH(0.99±0.88 vs1.50±1.76 U/L)显著下降(P<0.05)。有输卵管积水患者鲜胚移植无临床妊娠,冻融胚胎移植(FET)周期临床妊娠率31.6%(6/19)、种植率16.7%(6/36),显著增高(P<0.05)。结论低剂量缓释达菲林降调联合CC与HMG应用于IVF促排卵可取得较为理想的临床结局。CC可有效抑制LH峰的出现,且不影响内膜发育;年龄与输卵管积水是影响预后的最重要的因素。

Objective:With the use of clomiphene citrate(CC) in late phase of controlled ovarian hyperstimulation to suppress LH surge in IVF long protocol with low dose depot Diphereline down regulation,the subsequent clinical outcomes and other prognosis factors were observed. Methods:Depot Diphereline 0.34 mg(0.2 ml) was injected 7 days after ovulation.hMG(150-225 IU) was injected on day 3-5 after the menses for 8 days,and then CC 50 mg was given daily until the day of hCG injection.The endometrial thickness and serum LH levels between CC starting day and hCG injection day,as well as clinical pregnancy rate,implantation rate and abortion rate were compared. Results:156 patients were enrolled.The clinical pregnancy rate,implantation rate and abortion rate in fresh embryo transfer(ET) cycles were 23.9%(22/92),13.6%(3/22) and 20.5%(23/112),respectively. In frozen ET cycles,clinical pregnancy rate and implantation rate were 33.3%(19/57) and 18.9% (21/111),respectively.The clinical pregnancy rate and implantation rate in frozen ET cycle were significantly higher than those in fresh ET cycle(P<0.01).Compared with that on CC starting day,the endometrial thickness on hCG injection day was significantly increased(11.3±3.1 vs 10.3±2.8 mm, P<0.05),and serum LH levels were significantly decreased(0.99±0.88 vs 1.50±1.76 IU/L,P< 0.05).None conceived in fresh ET in the patients with hydrosalpinx. Conclusions:Reasonable outcomes can be obtained in the low dose depot Diphereline down regulation protocol combined with using clomiphene citrate in late phase of controlled ovarian hyperstimulation.CC can effectively suppress LH surge without adverse effects on endometrial development.The most important prognosis factors are age and hydrosalpinx.