来曲唑或氯米芬联合人绝经期促性腺激素用于PCOS妇女促排卵疗效的比较

Comparison of effects of letrozole or clomiphene citrate combined with HMG for ovulation induction in women with polycystic ovary syndrome

目的评估来曲唑(LE)或氯米芬(CC)联合人绝经期促性腺激素(HMG)用于多囊卵巢综合征(PCOS)妇女促排卵的效果。方法回顾性分析接受促排卵治疗的211例PCOS不孕妇女,按促排卵方案分为LE+HMG、CC+HMG以及单用HMG组,比较三组排卵率、妊娠率、单卵泡发育率、促排卵时间以及HMG剂量的差异。结果 LE+HMG组排卵率为91.5%,CC+HMG组86.8%,HMG组71.7%,LE+HMG和CC+HMG组显著高于单用HMG组(P<0.01);LE+HMG组单卵泡发育率显著高于HMG组(85.3%vs.60.5%,P<0.01),但CC+HMG与其他两组比较无统计学差异(P>0.05);LE+HMG、CC+HMG、HMG三组患者的妊娠率分别为25.3%、22.7%和26.3%,组间无统计学差异(P>0.05);LE+HMG组促排卵时间为(15.07±2.41)d,CC+HMG组为(15.27±2.47)d,HMG组为(16.91±2.66)d,三组中HMG剂量分别为(482.3±168.2)U、(486±169.0)U和(595.5±196.6)U,LE+HMG和CC+HMG组促排卵时间及HMG剂量均显著低于HMG组(P<0.01)。结论 LE或CC联合HMG不仅缩短促排卵时间和减少HMG用量,并且提高了排卵率;此外,LE联合HMG更易得到单优势卵泡发育。

Objective： To evaluate the effectiveness of letrozole （LE）or clomiphene citrate （CC）combined with HMG for ovulation induction in women with polycystic ovary syndrome（PCOS）. Methods： The data of 211 infertile women with PCOS undergone ovulation induction treatment were collected for the retrospective study. The patients were divided into three groups according to the treatments：LE＋ HMG,CC＋ HMG, and HMG-only. The ovulation and pregnancy rate, the rate of mono follicular development, HMG dose used per cycle and the mean duration of treatment were compared among the three groups. Results： The ovulation rate in LE＋ HMG group （91.5%）and CC＋ HMG group （86.8%）was significantly higher than that in HMG-only group （71.7%） （P〈0. 01） . The rate of mono follicular development in LE＋ HMG group was significantly higher than in HMG-only group（85.3% vs. 60.5%, P〈0.01）,but not significantly higher than in CC＋ HMG group. No significant differences were found in pregnancy rates among three groups（25.3% vs. 22.7% vs. 26.3%,P〉0.05）. The mean duration of treatment in LE＋HMG group [（15.07±2.41）days] and in CC＋ HMG group [（15.27±2.47）days] was significantly shorter than that in HMG-only group [-（16.91 ± 2.66） days] （P〈0.01）. HMG dose used in LE＋HMG group [-（482.3±168.2）U] and CC＋ HMG group [（486±169.0）U] was significantly lower than that in HMG-only group [（595.5±196.6）U]（P〈0.01）. Conclusions： LE or CC combined with HMG not only reduces the duration of stimulation and total HMG dose used for ovulation induction,but also achieves higher ovulation rate. Moreover,administration of letrozole combined with HMG is helpful to obtain mono follicular development.