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자연 월경주기와 Clomiphene Citrate 유도주기를 이용한 체외수정 및 배아이식술의 의의

Comparisons os the Outcomes between Nonstimulated Cycles and Clomiphene Stimulated Cycles in IVF & ET

대한산부인과학회지 1993년 36권 4호 p.521 ~ 533
임성호
권혁찬

Abstract


Ovulation induction with various hormonal agents has become a standard component of in vitro fertilization (IVF) cycles to obtain multiple oocytes. Among the advantages of controlled ovarian hyperstimultion are the increased numbers of oocytes
and
thus
embryos that are available for embryo transfer (ET)and the enhanced cycle control that is achievable, especially with the concurrent use of the gonadotropin-releasing hormone analogues (GnRHa). However, controlled ovarian hyperstimulation
increases
the
cost of the cycle and is associated with decreased endometrial receptivity. In addition, some patients, including those with regular ovulatory cycles, do not respond to ovarian stimulatory drugs.
Recent communications have reported successful pregnancies after IVF in unstimulated cycles and clomiphene citrate stimulation cycles, triggered with or without human chorionic gonadotropin(hCG).
In this study, our objections is to describe the clinical experience of our center with in vitro fertilization(IVF) in unstimulated cycles and clomiphene stimulated cycles and to provide a comparison to each other. We report our results in 67
patients,
96 cycles spontaneously ovulatory women with predominantly pelvic and tubal factor as their principal cause of infertility, under the age of 40 and no male factor, and 26 patients, 34 cycles clomiphene citrate stimulated ovulatory women with
additional
ovulatory factor.
In the ninty six spontaneously ovulatory cycles, sixty six follicle aspirated cycles (oocyte retrieval rate; 68.8%) resulted in nine clinical pregnancies(18.4%) and in the thirty four clomiphene citrate stimulated ovulatory cycles, twenty seven
follicles aspirated cycles (oocyte retrieval rate; 79.4%) resulted in three clinical pregnancies (15.8%). There was no statistically significance in pregnancy rate between two group.
We conclude that favorable results can be obtained not only from the unstimulated IVF but also from the clomiphene citrate stimulatory IVF.
The unstimulated IVF and only clomiphene citrate stimulatory IVF are the viable alternatives to gonadotropins stimulated cycles with pregnancy rates approximatly one half those of stimulated cycles. It is reasonable to offer patients up to three
cycles
of unstimulated IVF and clomiphene citrate stimulation IVF without expecting a decrease in pregnancy rates.

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