To Observe The Inhibition Effect Of Clomiphene Citrate On Luteinizing Hormone Surge In The Stimulation Procedure Of Controlled Ovarian

According to statistics,the incidence of infertility was 15%-20% in foreign countries and about 5% in our country.Since the first test-tube baby was born in 1978 [1],In vitro fertilization embryo transfer(IVF-ET)is an effective treatment for infertility.The controlled ovarian hyperstimulation(COH)is one of the important steps of in vitro fertilization/intracytoplasmic sperm injectioin-embryo transfer(IVF/ICSI-ET)and the prevention of luteinizing hormone(LH)peak is the key link to COH.Long programs for pituitary by GnRH-a drop to adjust effectively the early onset of LH peak has been as the first selection of the reproductive center stimulate ovulation.But the treatment cycle is long,expensive,high risk of OHSS problems have been faced by clinicians.Chlorine meters Finn(CC)as first-line stimulate ovulation drugs are widely used in clinical stimulate ovulation,in recent years,the use of the CC in combination with low dose designed.the Gn scheme of micro stimulation [2] because of low cost,short treatment period,high ratio of embryo,and low risk of OHSS is more and more used by clinicians,but because of the stimulus was less number of oocytes,the causes for the relatively small number,the cumulative low success rate of embryos,in domestic has only used in older age,poor ovarian function of patients and has not become the mainstream in [3] stimulate ovulation.In our reproductive center patients with normal ovarian reserve function,will target oocytes number as 10-15,on the premise of not decrease designed the Gn,according to the use of CC can inhibit the early onset mechanism of LH peak,try under the high estrogen levels by CC to inhibit pituitary positive feedback effect to replace traditional down regulation of the pituitary gland.Literature reports before the premise of CC inhibitory effect of LH peak is mostly natural cycle or micro stimulation cycle,namely in estrogen levels < 2000 pg/ml,and CC under ultra high estrogen levels stimulate ovulation scheme can suppress early-onset LH peak,there is no literature reports.The study focuses mainly on the application of a non-down-regulation ovulation induction program combining CC withLE and Gn,which can be applied on patients with normal ovarian reserve function to find out if there is an inhibition effect on LH peak.Objective: To investigate the inhibition effect of clomiphene citrate(CC)on luteinizing hormone(LH)in the stimulation procedure of controlled ovarian.Methods: A retrospective analysis was conducted of the clinical data of 98 patients with normal ovarian reserve function receiving ovulation induction program combining CC with and Gn at our center from April 2013 to October 2014,including baseline,2 days before ovulation induction,1 day before ovulation induction,LH at the ovulation induction day,average ovum obtaining number,M II ovum rate,normal fertilization rate,embryo available rate,high quality embryo rate,basic endometrial thickness,endometrial thickness at the the ovulation induction day,implantation rate and clinical pregnancy rate.Results: The LH level was 3.19±2.17 miu/ml at baseline,4.25±2.7 miu/ml at 2 days before ovulation induction,4.7±2.53 miu/ml at 1 day before ovulation induction,5.85±3.57 miu/ml at the ovulation induction day.Average LH levels at baseline,2 days before ovulation induction,1 day before ovulation induction and the ovulation induction day were all less than 10 mIU/ml and the data showed an increasing trend.By comparing the LH levels between two adjacent time points or the LH levels at other time points with the baseline,there existed statistically significant differences,respectively,except that there was no significant difference between 1 day before the HCG day and 2 days before the HCG day.Among the patients,there were 9 cases showing persistent high LH without affecting the ovum obtaining and pregnancy outcomes.The Gn dosage was 2142.23±712.57 IU,the Gn duration was 10.4±1.81 days,the average ovum obtaining number was 12.33±6.29,the endometrial thickness at the HCG day was 9.45±2.20 mm,the maturation rate was 86.8%(1071/1235),the normal fertilization rate was 74.1%(794/1071),the high quality embryo rate was 52.0%(412/794),the available embryo rate was 80.3%(638/794),the ovum obtaining cycle was 98,the number of fresh embryo transfer cycles was 60,and the clinical pregnancy rate was 51.7 %(31/60).9 cases with high LH,the implantation rate was 30%,the clinical pregnancy rate was 60%,no impact on oocytes and pregnancy outcome.Conclusion:CC infertility in normal ovarian reserve function in the process of controlled ovarian stimulation in patients with early-onset LH peak was effectively inhibited,regular fresh embryo transfer,not reduce clinical pregnancy rate,and LE + CC + HMG ovulation of the falling tone than promoting economic,safe,convenient and repeatable,to reduce the OHSS occurred,can be widely applied in clinical.