促性腺激素释放激素激动剂治疗不孕症合并子宫腺肌病

Gonadotrapin-releasing hormone agonist for the treatment of infertility complicated with adenomyosis

目的 探讨促性腺激素释放激素激动剂(GnRH-α)对不孕症合并子宫腺肌病的疗效。方法 对12例不孕症合并子宫腺肌病行GnRH-a治疗,每月肌注抑那通3.75mg,连用6个月,同时加用利维爱作“反向添加治疗法”;停用GnRH-a后,部分病例应用促排卵和官腔内受精(IUI)。治疗前、后分别进行B超、核磁共振(MRI)检查,血清CA_(125)、生殖激素(FSH、LH、E_2)及骨密度(BMD)测定。结果 治疗后痛经等症状缓解,B超和MRI提示子宫腺肌病病灶基本消退,子宫大小恢复正常占83.33％(10/12),血CA_(125)、FSH、LH、E_2水平显著降低(P<0.01),腰椎BMD无明显变化(P>0.05),妊娠率达75.0％。结论 CnRH-α是治疗不孕症合并子宫腺肌病的一种有效方法,辅助诱导排卵和IUI,妊娠率进一步提高;应用GnRH-α时,可加用适量的激素补充疗法。

Objective To study the effect of gonadotropin-releasing hormone agonist (GnRH-a) on infertility complicated with adenomyosis. Methods GnRH-a and sex-steroid add-back therapy were used for twelve patients with infertility complicated with adenomyosis with a dosage of 3.75mg/m for6 months.After withdrawing the GnRH-a,assisted reproductive technology (ART) was used in some of them.Examinations for B-ultra sonography (B-us),MRI,BMD,blood CA125 and sexual hormone were done before and after the therapy. Results After the treatment,the symptom of dysmenorrhea was relieved. B-us and MRI showed focus of adenomyosis disappeared and the volume and size of uteri recovered in 83.33% .The levels of blood CA125 ,FSH,LH,EI decreased significantly ( P < 0.01 ). Lumber bone marrow density (L-BMD) had no significant changes (P>0.05) .The pregnant rate was 75.0%. Conduaons GnRH-a seams effective for the treatment of infertility with adenomyosis. The pregnant rate can be improved significantly with ART. HRT is considered necessary when using GnRH-a.