使用克罗米芬，会影响鲜胚移植的内膜厚度和妊娠率吗？

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OBJECTIVE

研究目的

Clomiphene citrate (CC) has been used as an adjunct to gonadotropin administration during fresh in vitro fertilization (IVF) cycles in patients with diminished ovarian reserve. As CC is a selective estrogen receptor modulator that has antiestrogenic properties at the level of the endometrium, use of CC could potentially have a detrimental effect on outcomes following fresh embryo transfer. The objective of this study was therefore to determine the impact of CC on endometrial lining thickness and pregnancy outcomes in women undergoing a fresh autologous embryo transfer.

在卵巢储备功能减退的患者中，克罗米芬常被用作新鲜胚胎移植周期中促性腺激素的辅助用药。克罗米芬作为选择性雌激素受体调节剂，对子宫内膜水平具有抗雌激素作用，所以克罗米芬的应用可能会对之后的新鲜胚胎移植有负面影响。故本研究的目的即在于明确克罗米芬在自体新鲜胚胎移植周期中对子宫内膜厚度及妊娠结局的影响。

MATERIALS AND METHODS

研究对象及方法

A retrospective chart review examined all gonadotropin stimulation cycles that resulted in autologous fresh embryo transfer performed at a single academic medical center between October 2019 and January 2022. Patients in the clomiphene citrate group took 100mg on day 1 through day 5 of stimulation. The primary outcomes were endometrial thickness and ongoing pregnancy (CIG). Chi-squared test and logistic regression were used to compare endometrial thickness and pregnancy outcomes among cycles with and without CC, with p<.05 defining significance. Regression models were adjusted for age.

回顾性分析2019年10月至2022年1月期间在一个单学术医疗中心进行促性腺激素刺激的所有自体新鲜胚胎移植周期病例。克罗米芬组自促排卵治疗第1天至第5天每天予克罗米芬100mg。主要结局为子宫内膜厚度和持续妊娠（宫内妊娠）。克罗米芬组和非克罗米芬组间子宫内膜厚度和妊娠结局采用方差检验和logistic回顾分析。P＜0.05认为差异具有统计学意义。

RESULTS

研究结果

One hundred seventy-three cycles were included, of which 27 utilized CC. Patients in the CC group were older (mean 39.5 vs. 37.9 years),had a lower AMH (0.91 vs. 2.45), lower estradiol on day of trigger (1619 vs.2248 pg/mL), fewer number of eggs retrieved (7.3 vs. 11.8), and fewer 2PNs (4.9 vs. 6.6) than patients whose cycles did not include CC. There was no difference in endometrial thickness between patients who did and did not use CC (10.3 vs. 11.1mm respectively, p¼0.16).Four of the 27 cycles (14.8%) that utilized CC resulted in ongoing pregnancy, while 48 of the 146 cycles (32.9%) without CC resulted in CIG. In the unadjusted model, use of CC appeared to have a significant negative impact on CIG (p=0.04), however, after adjusting for age, CC no longer remained a significant predictor of outcome (p=0.14). There was no difference in SAB or biochemical pregnancy rate between the two groups (p=0.09).

共纳入173个周期，克罗米芬组为27个周期。与非克罗米芬组相比，克罗米芬组年龄较大（平均年龄39.5 vs 37.9岁），AMH较低（0.91 vs 2.45），扳机日雌二醇水平较低（1619 vs 2248 pg/ml）,获卵数较低（7.3 vs 11.8)，正常双原核数量较少（4.9 vs 6.6）。克罗米芬组的27个周期中4个周期获得持续妊娠，而非克罗米芬组的146个周期中48个周期获得宫内妊娠。在未调整模型中，发现克罗米芬对宫内妊娠有明显的负面影响（P=0.04）,然而，根据年龄调整后，克罗米芬不再是结局的重要预测因子（P=0.14）。两组在自然流产和生化妊娠率方面没有差异（P=0.09）。

CONCLUSIONS

结论

Use of CC was associated with older patient age and lower levels of AMH, estradiol on day of trigger, number of eggs retrieved and number of 2PNs, but did not independently impact endometrial thickness or pregnancy outcomes during fresh transfer cycles.

在新鲜胚胎移植周期中，克罗米芬与患者的高龄、AMH水平低、扳机日雌二醇水平低、获卵数少及正常双原核数量减少相关，但不是子宫内膜厚度及妊娠结局的独立影响因素。

IMPACT STATEMENT

影响声明

Clomiphene citrate does not impact endometrialthickness or ongoing pregnancy in patients undergoing fresh embryo transfer.

在新鲜胚胎移植周期中，克罗米芬对子宫内膜厚度及持续妊娠无明显影响。

原始出处：

DOES THE USE OF CLOMIPHENE CITRATE DURING GONADOTROPIN STIMULATION IMPACT ENDOMETRIAL THICKNESS AND CLINICAL PREGNANCY RATE DURING FRESH TRANSFER CYCLESUrsillo, Lauren et al.Fertility and Sterility, Volume 118, Issue 4, e316 - e317