促性腺激素对于下丘脑-垂体性闭经不育患者助孕治疗的疗效观察

Effect of assisted reproductive therapies with gonadotropins on infertility patients with hypothalamic-pituitary amenorrhea

目的总结下丘脑-垂体性闭经不育患者进行辅助生育治疗的结局及治疗特点。方法收集2001年2月至2009年2月在北京协和医院辅助生育中心行助孕治疗的76例下丘脑-垂体性闭经患者的临床资料,回顾性分析促性腺激素刺激卵巢进行诱导排卵或行体外受精(IVF)的反应性及治疗结局。结果 76例患者共进行了136个促性腺激素刺激卵巢周期(诱导排卵周期127个,IVF周期9个)。总有效治疗周期124个(有效的诱导排卵周期115个,IVF周期9个),因各种原因取消的周期12个,诱导排卵的有效率90.55%(115/127)。生化妊娠周期1个,临床妊娠周期57个,每个有效治疗周期的临床妊娠率为45.97%(57/124)。76例患者中,73例获得了有效治疗周期,共有53例临床妊娠,患者的累计妊娠率为72.6%(53/73);40例患者在第1个有效治疗周期即成功妊娠,即第一个治疗周期的妊娠率为54.8%(40/73)。结论应用外源性促性腺激素是治疗下丘脑-垂体原因无排卵不育的有效方法,可获得较好的排卵率和妊娠结局。

Objective： To summarize the characteristics of assisted reproductive therapies in patients with hypothalamic-pit uitary amenorrhea. Methods： Seventy-six patients with hypothalamic-pituitary amenorrhea treated in assisted reproductive technology （ART） center in Peking Union Medical College Hospital from Feb. 2001 to Feb. 2009 were analyzed retrospectively. All patients in the study were diagnosed with amenorrhea and anovulation for hypothalamic-pituitary or hypogonadotropic problems. The ovulation induction or in vitro fertilization and embryo transfer （IVF-ET） were used as treatment protocols. Results： There were a total of 136 treatment cycles in 76 women, of which 127 were ovulation induction （OI） cycles and 9 were IVF cycles. 1 to 5 cycles were applied for individual patient. Ovulation was observed in 115 OI cycles and the ovulation rate was 90.55% （115/127）. All the 9 IVF cycles had follicular maturation and 3 to 20 mature oocytes were picked up for each cycle. 12 cycles were cancelled for poor responses to gonadotropins, thin endometrium or other factors, with poor response as the primary reason for cycle cancellation. In 124 effective cycles, 57 clinical pregnancies and 1 biochemical pregnancy were achieved. The clinical pregnancy rate was 45.97% （57/124）. In total 76 patients, 73 got effective treatment cycles, 53 got clinical pregnancy. The cumulative pregnancy rate was 73. 6 % （53/73）.40 patients got clinical pregnancy in the first treatment cycle and the first cycle pregnancy rate was 54. 52% （40/74）. Conclusions. Ovulation induction with exogenous gonadotropins is an effective method for hypothalamic-pituitary anovulation, with satisfactory ovulation rate and pregnancy rate.