来曲唑促排卵的个体化应用

Individual application of letrozole for ovulation induction

目的:探讨来曲唑(LE)促排卵的个体化用药方法。方法:①收集近期不孕症门诊Ⅱ型排卵障碍患者78例、185个促排卵周期,其中多囊卵巢综合征(PCOS)152周期,其他排卵障碍33周期。②以诊断为依据选择LE启动剂量为2.5 mg和5.0 mg;适时添加HMG。③起始用药时间多于月经第5天开始,超过月经5天以上者,在内膜厚度<6 mm且处于增生期(A型)的前提下直接启动;用药天数以5天为准,根据卵巢反应性适度增减。结果:①153(82.3%)周期使用5.0 mg,32(17.7%)周期使用2.5 mg;PCOS 135(88.8%)周期使用5.0 mg,17(11.2%)周期使用2.5 mg;47(25.4%)周期辅以HMG。②月经周期3～5天启动163(88.1%)周期;6～8天启动17(9.2%)周期;9天以上启动5(2.7%)周期;用药3～5天171(92.4%)周期,6～7天13(7.0%)周期,8～9天1(0.6%)周期。③11周期促排卵失败,174周期成功,成功率94.1%;62例成功妊娠,累计周期妊娠率79.5%,每排卵周期妊娠率33.5%;成功妊娠者平均促排卵2.4周期;每周期平均排卵数1.2个;双胎妊娠1例,无中度以上卵巢过激综合征(OHSS)。结论:通过以诊断为依据选择合适的剂量并适时辅以HMG、灵活掌握启动时间和用药天数等个体化用药方法,能明显提高LE的促排卵效率。

To explore the method of individual application of letrozole for ovulation inductiorL Methods： A total of 78 patients （185 cycles） with type I1 ovulation barrier were collected from infertile outpatient, including 152 cycles of polycystic ovary syndrome （PCOS） and 33 cycles of other ovulation barriers. The start doses of letrozole were designed at 2. 5 mg and 5.0 mg according to diagnostic criterion; human gonadotropin （HMG） was added in due time. The start time of letrozole application was on the fifth day of menstruation, for the patients more than five days of menstruation, the treatment started on condition of thickness of endometrium 〈 6 mm and during proliferative phase; five days were designed as a course of treatment, then the time was increased and decreased appropriately according to o- varian reaction. Results： The start dose of 153 cycles （82. 3% ） was 5.0 rag, and the start dose of 32 cycles （ 17.7% ） was 2. 5 mg. The start dose of 135 PCOS cycles （88. 8% ） was 5.0 rag, and the start dose of 17 PCOS cycles （ 11.2% ） was 2. 5 rng. 47 cycles （25.4%） were supplemented with HMG. 163 cycles （ 88. 1% ） started at 3 - 5 days of menstruation; 17 cycles （9.2%） started at 6 - 8 days of men- struation; 5 cycles （2. 7% ） started at more than 9 days of menstruation; 171 cycles （92.4%） were treated for 3 -5 days, 13 cycles （7.0%） were treated for 6 -7 days, one cycle （0. 6% ） was treated for 8 -9 days. Eleven cycles failed for ovulation induction, 174 cycles succeeded, the success rate was 94. 1%. A total of 62 women got pregnancy successfully, the accumulative cycle pregnancy rate was 79. 5%, the pregnancy rate of per ovulatory cycle was 33.5% ; the mean cycles of ovulation induction among the pregnant women was 2. 4 cycles. The mean number of ovulation per cycle was 1.2 ; one woman got twin pregnancy, no more than moderate ovarian hyperstimulation syndrome （OHSS） occurred. Conclusion： Choosing appropriate dose according to diagnostic criterion and auxiliary application of HMG, grasping individual application, including the start time and application time flexibly, can improve the efficacy of ovulation induction with letrozole.