氯米芬诱导多囊卵巢综合征患者排卵6个周期的临床观察

Clinical study on the six cycles of clomiphene citrate in ovulation induction in polycystic ovary syndrome patients

目的观察氯米芬对多囊卵巢综合征（polycystic ovary syndrome,PCOS）患者诱导排卵6个周期的临床疗效。方法 2015年1月至2016年1月四川省妇幼保健院生殖医学中心对收治的186例PCOS患者口服氯米芬50-150 mg诱导排卵,阴道B超监测卵泡和子宫内膜生长。最大卵泡平均直径≥18 mm时,肌注人绒毛膜促性腺激素（human chorionic gonadotrophin,HCG）10 000 IU。如未孕则进行第2个周期诱导排卵,最多6个周期。观察相关临床指标。结果氯米芬用量、使用补佳乐患者比例、排卵时处于的月经周期时间随着周期的增加而增加（P〈0.05）。注射HCG日子宫内膜厚度及A型内膜比例、成熟卵泡数、最大卵泡平均直径、排卵数各周期比较差异无统计学意义（P〉0.05）。第1-6个周期妊娠率分别为：26.79%、18.54%、11.54%、8.70%、7.14%、3.85%,妊娠率随周期增加下降。累积妊娠率逐渐上升,6个周期累积妊娠率为56.40%。结论氯米芬诱导PCOS患者排卵,周期妊娠率逐渐下降,周期数控制在4个周期为宜。

Objective To investigate the effects of clomiphene citrate（CC） in ovulation induction in polycystic ovary syndrome（PCOS） patients for six cycles.Methods 186 cases of PCOS patients treated in Reproductive Medicine Center of Sichuan Provincial Hospital For Woman and Children from January 2015 to January 2016 were selected,they were given CC 50 - 150 mg for ovulation induction.The follicle diameter and endometrial thickness were monitored by the transvaginal ultrasound.When the diameter of the biggest follicle reached 18 mm,10 000 IU human chorionic gonadotrophin（HCG） was injected to trigger ovulation.The patients took thenext cycle of ovulation induction if not pregnant,up to 6 cycles.Observed related clinical indexes.Results The dose of CC,the ratio of patients using estradiol valerate tablets,the ovulation day on menstrual cycle were increased by cycles（P〉0.05）.The thickness and A type of endometrial on the day of injecting HCG,the numbers of mature ovulation follicles,and the maximum follicle diameter had no significant difference in six cycles（P〈0.05）.The pregnancy rate of six cycles were 26.79%,18.54%,11.54%,8.70%,7.14% and3.85% respectively,the rate of pregnancy decreased when cycles increaced.The cumulative pregnancy rate rose gradually,the cumulative pregnancy rate of six cycles was 56.40%.Conclusions The cumulative pregnancy rate decreases in cycles of CC induced ovulation.The cycles should be best controlled in 4.