微刺激周期和自然周期体外受精／卵胞浆内单精子注射一胚胎移植治疗的对照研究

目的 探讨在高龄、反复体外受精（IVF）失败、优质胚胎率低下、或卵巢功能减退患者,比较使用克罗米芬微刺激周期和自然周期IVF/卵胞浆内单精子注射（ICSI）治疗中的临床参数指标的差异.方法 将月经第2天窦卵泡直径〈8 mm,雌二醇（E2）〈290 pmol/L的患者分为微刺激周期组43例,从第3天开始服克罗米芬50 mg至取卵日,第8天B超监测,酌情增加人绝经期促性腺激素（HMG）注射;自然周期组43例为对照组.两组均在卵泡直径〉15 mm,E2值1,100 pmol/L时,22：30肌注达菲林0.2 mg.在内膜达8～14 mm时行胚胎移植.否则实行胚胎的玻璃化冷冻,待日后进行自然周期移植.结果 与自然周期相比,克罗米芬周期提高了取卵成功率和优质胚胎率,降低卵母细胞早排率和周期取消率.但移植周期妊娠率、胚胎种植率均无显著性差异.结论 克罗米芬微刺激周期和自然周期对于卵巢功能低下患者的体外受精周期,具有相似的治疗效果.但是克罗米芬微刺激周期在所获得的卵母细胞质量等指标上略胜一筹.

Comparison of minimal stimulation cycles with clomiphene citrate and natural cycles in IVF / ICSI treatment

Objective： To investigate the clinical outcomes of minimal stimulation cycles with clomiphene citrate and natural cycles in IVF/ICSI treatment for the patients at advanced age with repeated IVF failure, lower rate of high-quality embryos or ovary dysfunction. Methods： Patients with antral follicle （8 mm in diameter and serum estradiol level （E2） 〈290 pmol/L on day2 of menstrual cycle were divided into two groups randomly： 43 cycles were given clomiphene citrate 50 mg from the day 3 of menstrual cycle to the day of oocyte retrieval and human menopause gonadotropin was given if needed; 43 natural cycles served as control. Ultrasound monitoring of follicles started on day 8. In both groups, triptorelin 0.2 mg was given at 22 ： 30 h when follicle diameter was〉15 mm and E2 was 1,100 pmol/L. Embryos were transferred if the thickness of endometrium reached 8-14 mm. Otherwise embryos were vitrified and would be transferred in the following natural cycle. Results： Compared with natural cycles, the clomiphene citrate cycles had more oocytes retrieved, higher rate of high quality embryos, lower egg escape rate and cancellation rate. Conclusions： For the patients with ovarian dysfunction, minimal stimulation using clomiphene citrate and natural cycle had similar clinic outcomes on pregnancy rate and implantation rate per transfer cycle. However, in clomiphene citrate cycles, the egg quality and some other parameters seemed better.