来曲唑与氯米芬诱导多囊卵巢综合征不孕症患者排卵效果观察

Comparison of effects of letrozole and clomiphene citrate on ovulation induction in the infertile women with polycystic ovary syndrome

目的比较来曲唑和氯米芬诱导多囊卵巢综合征(polycystic ovary syndrome,PCOS)不孕患者排卵的临床疗效。方法将189例PCOS不孕妇女分为来曲唑组(65例)和氯米芬组(124例),在月经周期第5天开始每日口服来曲唑5 mg或氯米芬100 mg。阴道B超监测卵泡和子宫内膜生长,内膜薄时口服戊酸雌二醇。最大卵泡平均直径≥18 mm时,肌肉注射人绒毛膜促性腺激素(HCG)10000 U。观察各种临床指标。结果来曲唑组卵泡期、黄体期子宫内膜厚度高于氯米芬组(P<0.05),戊酸雌二醇用量小于氯米芬组(P<0.05),注射HCG日子宫内膜厚度及A型内膜比例两组差异无统计学意义(P>0.05)。来曲唑组的优势卵泡数、成熟卵泡数、排卵数、卵巢过度刺激综合征(OHSS)发生率低于氯米芬组,单卵泡率高于氯米芬组(P<0.05)。卵泡生长时间、排卵率、妊娠率、多胎妊娠率、流产率比较两组差异无统计学意义(P<0.05)。结论来曲唑诱导PCOS患者排卵在子宫内膜厚度、单卵泡发育、OHSS发生率方面优于氯米芬,排卵率、妊娠率与氯米芬相似。

Objective To compare the effects of [etrozole and clomiphene citrate（CC） on ovulation induction in the infertile women with polycystic ovary syndrome（PCOS）. Methods One hundred and eighty-nine cases of infertile women with PCOS were randomly divided into two groups ： letrozole group （ n = 65 ） and CC group （ n = 124 ）. The follicle diameter and endometrial thickness were monitored by the transvaginal ultrasound. The women were administrated with estradiol valerate tablets when their endometrial was thin. When the diameter of the biggest follicle reached 18 mm, 10000 IU human chorionic gonadotrophin（HCG） was injected to trigger ovula- tion. Results The endometrial during follicular and luteal phases in the letrozole group were much thicker than that in the CC group, and the dosage of estradiol used for the CC group was less than that for the letrozole group（P 〈 0. 05 ）. There was no significant differ- ence in the endometrial thickness and A type of endometrial on the day of HCG between the two groups. The numbers of dominant, mature and ovulation follicles and the rate of ovarian hyperstimulation syndrome（ OHSS）were less in the letrozole group than those in the CC group,but the rate of single follicle was higher in the letrozole group than that in the CC group（ all P 〈 0. 05 ）. The stimulation follicle days, the rate of ovulation, pregnancy, multiple pregnancy and spontaneous abortion were not significant differences between the two groups. Conclusions Letrozole is better than CC in term of endometrial thickness, single follicle rate and lower OHSS rate, while the rates of ovulation and pregnancy are not different between the two groups..