促排卵治疗与残留卵泡

Ovarian stimulation and retained follicles

在生育年龄的不育症妇女中，排卵障碍约占20％～40％，其中多囊卵巢综合征（PCOS）占无排卵性不孕症的约1／3。促排卵治疗应用于排卵障碍所致不孕症及正常排卵女性进行助孕技术超排卵刺激周期。常用的促排卵药物包括枸橼酸氯米芬（克罗米芬，CC），人绝经期促性腺激素（HMG），重组促性腺激素（r—FSH），人绒毛膜促性腺激素（HCG）及促性腺激素释放激素激动剂（GnRH—a）等。随着促排卵药物的广泛应用，部分患者在使用促排卵治疗后的下一个周期，卵巢会出现分泌激素的囊肿，因其为优势卵泡排卵后闭锁不良的卵泡，

Objective： To examine the influence factors on retained follicle in ovarian stimulation. Methods： 355 cases of infertile women undergoing ovarian stimulation with three methods [-clomiphene citrate （CC）, human menopausal gonadotrophin （HMG）, CC/HMG] and intrauterine insemination （IUI） therapy were included. A single dose of human chorionic gonadortropin （HCG） or triptorelin was injected to induce ovulation. The patients were divided into two groups, polycystic ovary syndrome （PCOS） group and non-PCOS group. The retained follicles were examined by ultrasound 14 days later or in the next menstrual cycle. Results： The retained follicle rate was significantly higher in PCOS group than in non-PCOS group （15.4% vs 7.1%, P=0. 014）. The retained follicle rate was higher in those treated with HMG than the other two methods in both two groups, though without statistical difference. The retained follicles were more in those treated with HCG than triptorelin in both two groups, without statistical difference either. PCOS patients undergoing ovarian stimulation with sequential CC/HMG had significantly higher retained follicle rate than non-PCOS patients with the same stimulation method （14.7% vs 4.3%, P=0. 013）. The retained follicle rate in PCOS patients undergoing ovulation induction with HCG was also significantly higher than non-PCOS patients with the same induction method （17.8% vs 7.6%, P=0. 020）. Conclusions： Retained follicle rate in patients undergoing ovulation induction with HMG may be declined with decreasing dose of HMG. And ovulation induction with GnRH-a may decrease the retained follicle rate in PCOS patients.