来曲唑促排卵治疗的临床观察

Clinical study on letrozole for induction of ovulation

目的观察来曲唑（LE）促排卵治疗的临床疗效.方法符合标准的患者67例服用LE治疗,记录卵泡发育、子宫内膜生长、宫颈黏液性状等指标,并与同期使用克罗米酚（CC）治疗患者进行比较.其中22例CC反应不良患者采用自身对比.结果LE促排卵治疗67个周期中42个周期有优势卵泡发育（62.7%）,35个周期在注射人绒毛膜促性腺激素（hCG）48～60 h内破裂排卵（排卵率83.3%）,卵泡期13.76 d,平均1.07/周期卵泡成熟,10个周期的子宫内膜出现明显的三线征（A型内膜率23.8%）,宫颈黏液平均11.52分,1个周期发生黄素化未破裂卵泡综合征（LUFS）,未出现卵巢过度刺激综合征（OHSS）,2例妊娠（4.76%）.22例CC反应不良患者服用LE后有13例发育出优势卵泡,LUFS和内膜＜7 mm各1例.结论LE有促卵泡生长的作用,并对CC反应不良患者有一定疗效;成熟卵泡破裂排卵率高,对生殖系统及全身的副反应小.

Objective： To observe the effect of letrozole （LE） on the induction of ovulation. Methods： Sixty-seven patients were treated with LE. The indices Of their follicle growth, endometrial development and cervix mucus score were observed and compared with those in the women treated with clomiphene citrate （CC）. In the LE group, 22 patients with a previous inadequate response to CC were studied in cross-over design. Results. Follicle development was seen in 42 of 67 LE treatment cycles （62. 7%）, which was lower than that of CC group （79.5%）, but the ovulation rate was higher in LE group than that in CC group （83.3% vs. 61.3%, P〈0.05）. Both the endometrial development （thickness of endometrium and the rate of type A endometrium） and cervix mucus score in LE group were better than those of CC group （P〈 0.01）. In 67 LE treatment cycles, there was only 1 LUFS and no OHSS, and 2 women became pregnant （4.76 %）. Among the 22 patients with CC resistance who were treated with letrozole, ovulation occurred in 13 patients. Conclusions： Oral administration of LE is effective for the induction of ovulation, even to the CC resistant cases. LE can avoid the unfavorable effects on the ovaries, endometrium and cervix mucus which are frequently seen with CC.