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대한생식의학회지 제25권 제3호 2010년
Poor responder 환자에서 Clomiphene Citrate 주기와 Controlled Ovarian Hyperstimulation 주기의 체외수정 결과 비교
성균관 대학교 의과대학, 삼성제일병원 산부인과
송지홍, 궁미경,
Efficacy of clomiphene citrate stimulated cycle in poor responders in in vitro fertilization
Song jh, Koong mk
The purpose of this study is compare IVF cycle outcome in poor responders between clomiphene citrate (CC) stimulated and controlled ovarian hyperstimulation (COH) protocol. A total of 94 patients responding poorly in previous IVF cycles (estradiol < 600 pg/ml or less than 3 oocytes retrieved) subsequently underwent either COH (COH group: 122 cycles, 68 patients) or CC-stimulated cycles (CC group: 43 cycles, 26 patients). CC was administered for five consecutive days starting on cycle day 3 at a dose of 100 mg daily. Serial transvaginal ultrasound examination was done from cycle day 8. Urine was collected 3-4 times before hCG injection for the detection of LH surge. The hCG was administered when serum estradiol reached greater than 150 pg/ml and mean follicle diameter > 16 mm. In COH group, ovarian stimulation was done using short protocol (GnRH-a/FSH/HMG/hCG). No difference in age or number of transferred embryos was found between CC group and COH group. COH group had significantly (p<0.05) higher mean peak level of E2 (810¡¾112 vs 412¡¾55 pg/ml) and greater number of retrieved oocytes (3.0¡¾0.2 vs 2.0¡¾0.2) than CC group. CC group had transferred embryos (1.8¡¾0.2) compared with (2.1¡¾0.2) in COH group. However, CC group had higher pregnancy rate than COH group per retrieval [26.9% (7/26) vs 6.2% (6/97)], or per transfer [31.8% (7/22) vs 7% (6/86)]. Although cycle cancellation rate in CC group (48.8%) was higher than that of COH group (21.3%), the pregnancy rate per cycle in CC group was still higher (16.3%) than COH group (4.9%). In addition, implantation rate in CC group was 17.5% (7/40), which was significantly (p<0.01) higher than 3.9% (7/180) in COH group. These data suggest that oocyte and embryo quality are lower in COH cycles of poor responders than CC cycles. We suggest that clomiphene citrate stimulated IVF cycle may be more efficient than COH IVF cycle in poor responders in terms of lower costs and higher pregnancy performance.
키워드 : Poor responder, IVF-ET, Clomiphene citrate, Controlled ovarian hyperstimulation
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