COH全程使用排卵藥D2~打破卵針可下降排卵針使用量

全程使用排卵藥clomid (D2~打破卵針)可下降排卵針使用量
卵子品質數量與受孕率並無減少
為避免clomid對子宮內膜之不良影響, 全數胚胎冷凍下週期再植入

J Hum Reprod Sci. 2015 Jul-Sep;8(3):142-5. doi: 10.4103/0974-1208.165151.

Clomiphene based ovarian stimulation in a commercial donor program.

Gupta S1, Satwik R1, Majumdar A1, Mittal S1, Tiwari N1.

Author information

Abstract

OBJECTIVE:

This study was conducted to compare an extended clomiphene-based ovarian stimulation regimen with the conventional antagonist protocol in donor-recipient cycles.

MATERIALS AND METHODS:

A total of 170 (N) donors were stimulated between January 2013 and December 2013. Conventional antagonist protocol (group I) was employed in (n1 = 31) cycles, and clomiphene was used in (n2 = 139) donor cycles (group II). 50 mg clomiphene was given simultaneously with gonadotropins from day 2 of the cycle until the day of trigger. The analysis was performed retrospectively for oocytes retrieved, fertilization rates, cycle cancelation, blastocyst formation, and pregnancy rates. The dosages, cost, and terminal E2 (estradiol) were also compared between the two groups.

RESULTS:

The donor age groups were comparable in both the groups. There were no unsuccessful egg retrievals with clomiphene. The pregnancy rate (positive beta human chorionic gonadotropin) was significantly higher in the clomiphene group (odds ratio: 2.453; P = 0.02). Similarly, fertilization rate was significantly higher in the clomiphene group (59.5/50.5, P = 0.04). Eggs retrieved were similar in both groups, but the terminal E2 was significantly higher in the clomiphene group (P = 0.001). Average gonadotropin used was also significantly lower in clomiphene group (P < 0.001).

CONCLUSION:

Clomiphene can effectively prevent luteinizing hormone surge and limit the dose of gonadotropins thus bringing down the costs and its negative impact on the endometrium and oocyte quality.

clomid使用於誘導排卵會造成子宮內膜延後黃體化1-2天

FSH使用於誘導排卵會造成子宮內膜提早黃體化1-2天

clomid使用於誘導排卵會造成子宮內膜延後黃體化1-2天&子宮內膜變差
reduction of pinopod formation in the mid-luteal phase (Creus et al., 2003). 
The glandular density is reduced 

http://humupd.oxfordjournals.org/content/12/5/617.full

黃體期補充黃體素對於人工受孕無明顯助益

黃體期補充黃體素對於人工受孕無明顯助益(8.7%  vs 9.3%)

clomid 機轉
clomid抑制下視丘estrogen receptors進而增加GnRH分泌. 進而增加FSH & LH分泌
clomid可增加E2 & P4分泌

http://humrep.oxfordjournals.org/content/25/10/2501.full

使用排卵藥會抑制LH surge

使用排卵藥會抑制LH surge

http://molehr.oxfordjournals.org/content/19/12/799.full

Letrozole懷孕率略高於clomid

Letrozole懷孕率略高於clomid

http://www.jhrsonline.org/article.asp?issn=0974-1208;year=2013;volume=6;issue=2;spage=93;epage=98;aulast=Kar

排卵藥搭配排卵針可達不錯活產率

排卵藥搭配排卵針可達不錯活產率
排卵藥搭配排卵針IVF vs 排卵針IVF活產率 (23% vs. 16-26%)

http://www.ncbi.nlm.nih.gov/pubmed/23152261

Letrozole, clomid藥物機轉

clomid 排卵藥之機轉為抑制腦下垂體雌激素接受體estrogen receptor
letrozole之機轉為抑制aromatase, 抑制testosterone轉化為estradiol
導致體內雌激素濃度下降, testosterone濃度提高

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2569859/

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排卵藥比較: Clomiphene vs. letrozole

排卵藥比較: Clomiphene vs. letrozole
Letrozole 比Clomiphene可能較可提高子宮內膜接受度之相關物質(LIF, DKK1, LIFR, FGF-22)之基因表現