来曲唑用于有排卵不孕症妇女的促排卵效果观察——与氯米芬的对照研究

A study about the effect of letrozole in ovulation induction in ovulatory infertile women-a comparison with clomiphene citrate

目的 探讨来曲唑用于有排卵不孕症妇女的促排卵效果及其对生殖激素的影响。方法 选择2005-06-01—2005-10-31北京大学第三医院拟行宫腔内人工授精（IUI），或指导同房，或供精人工授精（AID）的111例有排卵的不孕症妇女，于月经周期第3～7天，每日口服来曲唑2．5mg（68例），或于月经周期第5～9天每日口服氯米芬（clomifene）50mg（43例）。超声监测卵泡发育，并于月经周期第8天和HCG日取静脉血测定黄体生成素（LH）、雌二醇（E2）、睾酮（T）和雄烯二酮（A）。当最大卵泡的平均直径／〉20mm时，肌注HCG 10000IU诱发排卵。观察排卵率、妊娠率、子宫内膜厚度及生殖激素的变化。结果 来曲唑组的排卵率和周期妊娠率与氯米芬组相似（P〉0．05），其优势卵泡数以及成熟卵泡数均显著低于氯米芬组（P〈0．01）。来曲唑组在HCG日子宫内膜的厚度显著厚于氯米芬组（P〈0、01）。其在月经周期第8天和HCG日血清E2水平均显著低于氯米芬组（P〈0、01），月经周期第8天血清A显著高于氯米芬组（P〈0．05），这种差异在HCG日消失，但血清T水平在两组之间没有差异来曲唑组在HCG日血清LH水平明显高于氯米芬组。结论 来曲唑用于有排卵的不孕症妇女，具有良好的排卵率，但其排卵率和妊娠率并未优于氯米芬，其能否作为一线的促排卵药物还需要进一步的研究结果来支持。

Objective To investigate the effect of letrozole as a drug for ovulation induction in ovulatory infertile women and influence on reproductive hormones. Methods A total of 111 ovulatory infertile women were recruited for IUI or timed intercourse or AID from Jun 1^st 2005 to Oct 31^st 2005. Ovulation was induced using 2. 5mg/day letrozole administered daily from day 3 to 7 of the cycle or 50mg/day CC from day 5 to 9 of the cycle. From day 8, ultrasound scan was performed to monitor follicle development. Blood sample was drawn on day 8 and day of HCG administration to test LH, E2 , T and A. When the diameter of the biggest follicle reached ≥20mm, 10 000 IU HCG was injected to trigger ovulation. Results In letrozole group the ovulation rate and pregnancy rate per cycle were similar to those of CC group （P 〉 0. 05 ）. Both the numbers of dominant follicle and mature follicle were significantly less in the former group than those in the latter group （ P 〈0.01 ）. The thickness of endometrium on the day of HCG administration in the letrozole group was much thicker than that in CC one （ P 〈0.01 ）. The level of E2 was much lower in the letrozole group （ P 〈0. 01 ） ,while androstenedione in serum was significantly higher than that in CC group on the day 8 of the cycle （ P 〈 0. 05 ）. There was no difference in serum testosterone between both groups. Although both groups had the same levels of LH on day 8, the letrozole group had much higher LH on day of HCG than CC one. Conclusion Letrozole can attain good ovulation rate in ovulatory infertile women. However, it is not better than CC in ovulation rate and pregnancy rate. Further investigation is needed to confirm if letrozole can be used as first line drug for ovulation induction.