来曲唑对不良反应的最小刺激

Journal of clinical gynecology and obstetrics Pub Date : 2019-09-30 DOI:10.14740/jcgo557

Ker Yi Wong, T. Ee, H. Tan

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引用次数: 1

摘要

背景:不良反应是指接受卵巢刺激反应不佳的妇女，对她们的最佳治疗尚未得到证实。与标准的长期方案相比，使用较低剂量促性腺激素的最小刺激已被证明能产生更少但更高质量的胚胎。因此，对于那些不能从较长时间和较高费用的治疗方案中获益的不良反应者，建议采用最小刺激。这项回顾性研究的目的是评估使用来曲唑进行最小刺激的不良反应者的结果，以及他们是否与新加坡三级中心的传统体外受精(IVF)的结果相当。方法:回顾性研究2011年3月至2014年3月期间在KK妇女儿童医院IVF中心接受最小刺激方案的43例不良反应者。该方案包括顺序给药来曲唑，然后是低剂量促性腺激素和促性腺激素释放激素(GnRH)拮抗剂。主要结局包括每位患者的临床妊娠率和活产率。对接受最小刺激方案和传统体外受精方案失败的妇女进行亚组分析，比较其结果。结果:刺激时的平均年龄为38.6岁。9名妇女(20.9%)实现临床妊娠，其中8名(18.6%)为活产。在亚组分析中，最小刺激方案获得的卵裂率为61.3%，明显高于传统试管婴儿周期获得的28.7%的卵裂率。两个周期的妊娠率和活产率无显著差异。结论:与传统体外受精方案相比，使用来曲唑的最小刺激方案在反应不良的患者中产生合理的活产率，并可能获得更高质量的卵母细胞。临床妇产科杂志，2019;8(3):77-80 doi: https://doi.org/10.14740/jcgo557

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Minimal Stimulation Using Letrozole in Poor Responders

Background: Poor responders refer to women who undergo ovarian stimulation with suboptimal response and an optimal treatment for them has yet to be proven. Minimal stimulation which uses lower doses of gonadotropins than standard long protocols had been shown to yield fewer but higher quality embryos. Minimal stimulation had thus been proposed as an option for poor responders who do not benefit from longer and higher cost regimens. The aim of this retrospective study was to evaluate outcomes of poor responders who underwent minimal stimulation using letrozole and whether they are comparable to outcomes of conventional in vitro fertilization (IVF) in a tertiary center in Singapore. Methods: This was a retrospective study of 43 poor responders who underwent minimal stimulation protocol in KK Women’s and Children’s Hospital IVF center between March 2011 and March 2014. The protocol involved sequential administration of letrozole followed by low-dose gonadotropins and a gonadotropin-releasing hormone (GnRH) antagonist. Primary outcomes included clinical pregnancy rate and live birth rate per patient. A subgroup analysis was done for women undergoing minimal stimulation protocol and having failed conventional IVF protocol in which their outcomes were compared. Results: The average age at time of stimulation was 38.6 years old. Clinical pregnancies were achieved in nine women (20.9%), out of which eight (18.6%) were live births. In the subgroup analysis, cleavage rate obtained in the minimal stimulation protocol was significantly higher at 61.3% compared to the cleavage rate obtained in the conventional IVF cycle at 28.7%. There were no significant differences in the pregnancy and live birth rates of the two cycles. Conclusion: Minimal stimulation protocol using letrozole produces a reasonable live birth rate in poor responders and potentially higher quality oocytes than conventional IVF protocol. J Clin Gynecol Obstet. 2019;8(3):77-80 doi: https://doi.org/10.14740/jcgo557

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Journal of clinical gynecology and obstetrics

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