来曲唑联合人绝经期促性腺激素对多囊卵巢综合征患者促排卵的临床研究

Letrozole combined with human menopausal gonadotropin for the induction of ovulation in women with polycystic ovarian syndrome

目的比较来曲唑(LE)联合人绝经期促性腺激素(HMG)与单独LE或HMG对多囊卵巢综合征(PCOS)患者的促排卵效果。方法拟行促排卵治疗的111例PCOS患者随机分为三组,A组为LE组(40例、49周期)、B组为LE+HMG组(42例、56周期)、C组为HMG组(29例、40周期)。患者在月经周期第3～5天开始,A组口服LE 2.5mg/d×5d;B组口服LE 2.5mg/d×5d后继续予肌注HMG 75U/d;C组肌注HMG,起始剂量为75U/d。比较三组的卵泡发育情况、子宫内膜厚度、绒毛膜促性腺激素(hCG)日血雌二醇(E_2)值和临床妊娠率。结果三组临床特征具有可比性。卵泡成熟时间、直径≥17mm卵泡数、hCG日子宫内膜厚度,A组与B、C两组比较均有显著性差异(P<0.05)。直径≥14mm卵泡数、hCG日E_2水平三组间比较均有显著性差异(P<0.05)。A组无反应取消率明显高于B组(P<0.05)。为防止发生卵巢过度刺激综合征(OHSS)放弃注射hCG者C组发生率明显高于A、B两组(P<0.05)。但三组临床妊娠率无显著性差异(P>0.05)。结论对于PCOS患者,LE+HMG是有效的促排卵方案,且可避免常规促排卵治疗中的子宫内膜变薄。

Objective： To compare that of HMG or LE alone （PCOS）. the effect of letrozole on the induction of （LE） plus human menopausal gonadotropin （HMG） with ovulation in women with polycystic ovarian syndrome Methods： One hundred and eleven patients with PCOS were recruited and randomly divided into three groups： LE （40 cases, 49 cycles）, LE＋HMG （42 cases, 56 cycles） and HMG （29 cases, 40 cycles）. From the third to fifth day of menstrual cycle on, patients in LE group took LE 2.5 mg daily for 5 days, patients in LE＋HMG group took LE 2.5 mg daily for 5 days followed by daily injection of HMG 75U, and patients in HMG group were treated with daily injection of HMG 75U. Follicular development, endo- metrial thickness, serum levels of estradiol （E2） on the day of hCG injection and pregnancy rate were determined and compared between groups. Results： There was no significant difference in clinical characteristics of the patients among the three groups. Patients in LE group took longer to achieve a dominant follicle and had fewer follicles 〉17 mm and thinner endometrium on the day of hCG injection when compared with those in LE＋ HMG group or HMG group （P〈0. 05）. The number of follicles 〉14 mm and serum level of E2 on the day of hCG were significantly different among the three groups （P〈0.05）. The cancellation rate due to no response was significantly higher in LE group than in LE＋ HMG group （P〈0.05）, while significantly more patients had the hCG injection canceled to avoid ovarian hyperstimulation syndrome （OHSS） in HMG group than in LE group or LE＋ HMG group （P〈0.05）. There was no significant difference in pregnancy rate among the three groups （P〉0.05）. Conclusions： LE-~HMG might be an effective method to induce ovulation in PCOS patients, with no evidence of detrimental effect on endometrium.