克罗米芬与GnRH拮抗剂两种温和刺激方案新鲜胚胎移植的治疗结局分析

目的:比较克罗米芬与GnRH拮抗剂两种温和刺激方案中新鲜胚胎移植的治疗结局,探讨克罗米芬温和刺激方案新鲜胚胎移植的选择策略。方法:回顾性分析本院341例接受体外授精-胚胎移植(IVF-ET)治疗的患者资料,其中应用克罗米芬温和刺激方案187例和应用GnRH拮抗剂温和刺激方案154例,比较两组IVF治疗结局,并比较克罗米芬温和刺激方案中,移植日不同子宫内膜厚度患者的治疗结局。结果:克罗米芬温和刺激方案组的Gn使用总量低于拮抗剂温和刺激组,移植日内膜厚度小于拮抗剂温和刺激方案组(均P0.05),但两组的年龄、BMI,基础促卵泡生成激素(FSH)、窦卵泡数(AFC)、Gn使用天数、获卵数、受精率、有效胚胎数、优胚率、移植胚胎数、种植率、临床妊娠率、继续妊娠率等未见统计学差异(P0.05)。克罗米芬温和刺激方案组中的种植率、临床妊娠率、继续妊娠率等随着移植日子宫内膜厚度的增加而增加,将内膜厚度分为9mm及≥9mm两组发现,种植率、临床妊娠率及继续妊娠率等均有统计学差异(均P0.05)。结论:克罗米芬温和刺激方案中选择新鲜胚胎移植可获得与拮抗剂温和刺激方案相似的治疗结局,当移植日子宫内膜厚度达到7mm时可选择新鲜胚胎移植,当厚度≥9mm时选择新鲜胚胎移植更为稳妥。且该方案减少了药物用量成本。

Analysis of fresh embryo transfer strategy and its outcome of patients after treated by two mild stimulation protocols which used clomiphene citrate or GnRH antagonist in IVF-ET

Objective:To compare the pregnant outcomes of patients treated by two mild stimulation protocols which used clomiphene citrate or GnRH antagonist in IVF-ET,to explore the fresh embryo transfer strategy of patients after treatment by clomiphene citrate(CC) as mild stimulation protocol.Methods:Data of 341 patients who underwent IVF -ET treatment were retrospectively analyzed.Patients were divided into CC group (n=187) and GnRH antagonist group (n=154).The IVF-ET outcomes of patients in two groups were compared.Furthermore in CC group,the IVF -ET outcomes of different patients in subgroups according to endometrial thickness on the day of embryo transfer were also compared.Results:The age,BMI,basal serum FSH,basal antral follicle count(AFC),the duration of gonadotropin,the number of retrieved oocytes,fertilization rate and obtained embryos,high-grade embryo rate,the number of embryos transferred of patients had no statistical significant difference between the two groups(P＞0.05).Compared to GnRH antagonist group,the total amount of gonadotropin (Gn) used significant decreased,and endometrial thickness on the day of embryo transfer significant decreased in CC Group (P＜0.05).Tn CC group,the clinical pregnancy rate,implantation rate,continued pregnancy rate of patients had increased with the more thicker endometrium on the day of embryo transfer.In CC group,the implantation rate,clinical pregnancy rate and continued pregnancy rate of patients with equal to or more than 9 mm endometrium on the day of embryo transfer were significant higher than those of pa tients with less 9 mm endometrium (P＜0.05).Conclusions:Comparing to the patients with mild stimulation protocol used GnRH antagonist,the patients with mild stimulation protocol used clomiphene citrate have the similar clinical outcomes.Fresh embryo can transfer when endometrial thickness of patients reaches 7mm,but it is better to transfer fresh embryo when endometrial thickness of patients reaches 9mm.This fresh embryo transfer strategy may reduce the costs of drugs.