取卵后黄体期应用来曲唑降低血中雌激素水平不降低卵巢过度刺激综合征发生率

Luteal letrozole administration decreases serum estrogen level but not the risk of ovarian hyperstimulation syndrome

目的:探讨取卵后黄体期药物干预体内雌激素水平对超促排卵后因卵巢过度刺激综合征(ovarian hyperstimulation syndrome,OHSS)行全胚冷冻患者的疗效。方法:将同期因OHSS行全胚冷冻的139例患者分为两组,治疗组43例在取卵后第1天起连续5 d口服来曲唑2.5 mg,每日2次,并同时给予扩容对症治疗;对照组96例在取卵后给予常规扩容、白蛋白等处理。测定两组患者取卵后第2、5、8天血清甾体水平,观察两组患者轻、中、重度OHSS发生比率、OHSS临床自觉症状程度。结果:与对照组比较,治疗组取卵后第2、5、8天血清雌二醇水平均明显下降(P<0.001),血清黄体生成素及孕酮水平两组间比较均差异无统计学意义(P>0.05)。治疗组43例,中、重度OHSS 7例(16.27%),对照组96例,重度OHSS 18例(18.75%),比较两组重度OHSS发生率差异无统计学意义(P=0.12)。结论:取卵后口服来曲唑可明显降低全胚冷冻OHSS患者黄体期血清雌激素水平,但并不能明显降低重度OHSS发生率。

To explore the efficiency of using aromatase inhibitors during luteal phase in in vitro fertilization IVF stimulated cycles for patients at high risk for ovarian hyperstimulation syndrome （OHSS）. Methods： A total of 139 infertile women undergoing assisted reproductive technique with high risk for OHSS were enrolled in this clinical trial. In the treatment group 43 patients received five consecutive doses of aromatase inhibitors （letrozole） and support therapy combined with embryo cryopreservation. In the control group 96 patients received support therapy alone. All the patients were evaluated clinically, echographically, hematologically and tested for their steroid hormone. Results： There was significantly lower estrogen level in the treatment group 2, 5 and 8 days after oocyte retrieval compared with the control group （P〈0.001）, There was no significant difference in luteinizing hormone and progesterone levels 2, 5 and 8 days after oocyte retrieval in the treatment group and control group （P〉0.05）. There were 7 cases of severe OHSS in the treatment group and 18 cases of severe OHSS in the control group. The rate of severe OHSS was not significantly different in the treatment group and control group （P=0.12）. No side effect was reported in either group. Conclusion： Treatment with letrzolein luteal phase decreases serum estrogen levels of patients after oocyte retrieval,but it couldn’t reduce the risk of severe OHSS.