下丘脑性闭经不孕患者治疗方案研究

Treatment Observation on Primary Infertility Hypothalamic Amenorrhea Caused by Idiopathic Hypogonadotropic Hypogonadism

目的探讨特发性低促性腺激素性性腺功能低下(IHH)导致下丘脑性闭经(HA)不孕患者的治疗方案和结局。方法收集2003年7月至2010年11月在本院接受治疗的11例确诊为IHH导致HA不孕患者的临床病历资料,采取回顾性分析法分析促性腺激素(Gn)刺激卵巢进行诱导排卵的反应性及治疗结局(本研究遵循的程序符合本院人体试验委员会所制定的伦理学标准,得到该委员会批准)。经人工周期治疗3个月后,采取A方案[人绝经期促性腺激素(hMG)+人绒毛膜促性腺激素(hCG)]和B方案[hMG+高纯度尿促卵泡素(HP-hFSH)+hCG]两种诱导排卵方案,优势卵泡发育成熟后,指导同房或宫腔内人工授精(IUI),排卵后予黄体支持治疗。结果 11例HA不孕患者共计进行26个周期Gn刺激卵巢治疗,以22个周期为治疗有效观察点(因各种原因取消4个周期),则诱导排卵有效率为84.61%(22/26)。在22个有效治疗周期中,11例患者临床妊娠为7例;妊娠结局:自然流产为1例,孕龄8个月时脐带绕颈致胎死宫内引产为1例,足月分娩为5例。周期妊娠率为31.82%(7/22),累积妊娠率为63.64%(7/11)。B方案的Gn用药时间短于A方案,两者比较,差异有统计学意义(P<0.05),而hCG日优势卵泡数和hCG日子宫内膜厚度与A方案比较,差异无统计学意义(P>0.05)。结论外源性Gn是治疗HA和无排卵性不育的有效方法,促排卵率高、妊娠结局较好。但是否值得推广,值得进一步研究证实。

Objective To explore characteristics and outcomes of reproductive therapies on patients with hypothalamic amenorrhea （HA）. Methods From July 2003 to November 2010, the data of 11 patients with HA who were treated in Jining First Peoplers Hospital were analyzed retrospectively. All the patients were diagnosed as idiopathic hypogonadotropic hypogonadism （IHH）. The ovulation induction followed treatment protocols. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Jining First Peopters Hospital. Informed consent was obtained from all participates. After taking the artificial cycle for 3 months, all the patients received ovulation induction solutions： Option A [-human menopausal gonadotropin （hMG） ＋human chorionic gonadotrophin （hCG）] and option B [-hMG＋ highly purified human urinary follicle stimulating hormone （HP-hFSH） -k hCG]. After dominant follicle developed and matured, patients were recruited for intrauterine insemination （IUI） or timed intercourse and then received luteal support therapy after ovulation. Results A total of 26 treatment cycles of ovarian stimulation treatment were conducted on 11 HA patients. Taking 22 treatment cycles as observation point, the ovulation rate was 84.61% （22/26）, and 4 cycles were cancelled for poor responses to gonadotropins, economic or other reasons. In 22 effective treatment cycles, 7 clinical pregnancies were achieved, in which 1 case was spontaneous abortion, 1 case died of umbilical cord around neck and 5 cases delivered at term. The cycle clinical pregnancy rate was 31.82% （7/22） and the cumulative clinical pregnancy rate was 63.64% （7/ 11）. Gonadotropin （Gn） medication time of option B was shorter than that in option A （P〈0.05）. The number of dominant follicle on hCG day and endometrial thickness on hCG day between two groups had no significant difference （P〉0. 05）. Conclusion Exogenous Gn is an effective way to treat HA caused by IHH and anovulatory infertility with satisfactory ovulation rate and pregnancy rate.