克罗米芬联合促卵泡素治疗多囊卵巢综合征的疗效观察

Analysis of the effects of clomiphene citrate and clomiphene citrate combined with different follicle stimulating hormone for the induction of ovulation in women with polycystic ovary syndrome

目的:比较单用克罗米芬(CC)及其联合不同促卵泡素(FSH)治疗多囊卵巢综合征(PCOS)患者的效果,以指导PCOS患者选择合适的促排卵方案。方法:选取2009年1月至2012年7月就诊于我院生殖门诊的81例PCOS患者(共92周期),患者均以CC促排卵,根据月经第8天的卵泡生长情况,决定是否联合应用基因重组促卵泡素(rFSH)或尿促卵泡素(uFSH)。按促排卵方案不同将患者分为3组:CC+HCG组(A组,26例,32周期);CC+rFSH+HMG+HCG组(B组,23例,26周期);CC+uFSH+HMG+HCG组(C组,32例,34周期)。患者排卵后均用黄体酮胶丸或地屈孕酮黄体支持12～14天。比较3组患者促排卵治疗的效果。结果:A组中2例患者发生黄素化综合征(LUFS);B组中4例发生轻度卵巢过度刺激综合征(OHSS);C组中1例发生重度OHSS,1例LUFS。3组患者的HCG日最大卵泡直径、内膜厚度、排卵率及妊娠率均无显著差异(P>0.05)。A组D8优势卵泡直径大于B、C组(P<0.05);至HCG日平均时间少于B、C组(P<0.05);B组直径≥1.5cm卵泡数和排卵数均显著高于A、C组(P<0.05)。B组与C组的至HCG注射日时间和FSH用量均无显著差异(P>0.05)。结论:CC促排周期D8优势卵泡直径大小对决定联合FSH治疗PCOS患者有一定的参考意义。单用CC促排卵可能抵抗周期,联合uFSH是经济有效的促排卵方案。

Objective：To obtain the appropriate ovulation induction plan for women with polycystic ovary syndrome（PCOS） by comparisons of the effects of the three groups for inducing ovulation by means of clomiphene citrate（CC） or clomiphene citrate combined with gonadotropin.Methods：81 PCOS women who attended for treatment on reproductive department in our hospital from Jan.2009 to Jul.2012 were chosen for this study.92 cycles were assessed.CC was given to all the women for 5 days from day 5 initially.Adding rFSH or uFSH for induction of ovulation was decided by the dominant follicle diameter on cycle day 8.Patients were divided into three groups：group A was given CC＋HCG（26 cases,32 cycles）,group B was given CC＋rFSH＋HMG＋HCG（23 cases,26 cycles）and group C was given CC＋uFSH＋HMG＋HCG（32 cases,34 cycles）.Progestin was given to the women for 12 to 14 days in ovulatory cycles for supporting luteum after ovulation.Effects of ovulation induction were compared in the three groups.Result：In group A two cases of LUFS occurred.In group B four cases of mild OHSS occurred.In group C one case of serious OHSS and one case of LUFS occurred.The data of the biggest follicular diameter and uterus intimal thickness on the day HCG administration and the data of ovulation rate and pregnancy rate in the three treatments were not significant（P＆gt;0.05）.The dominant follicle diameter on cycle day 8 in group A showed larger than that in the other two groups.The number of the follicle with diameter bigger than 1.5cm and the number of ovulation were larger in group B than in the other two groups.（P＆lt;0.05） The time to the day HCG administration and the total doses of FSH used did not show significant between group B and group C（P＆gt;0.05）.Conclusion：The dominant follicle diameter on cycle day 8 may provide reference in the condition of deciding using gonadotropin properly when CC applied in PCOS women.CC combined with uFSH is economical and effective when the cycle may resist CC used only.