PCOS患者使用不同促排卵药与卵泡提前黄素化的关系

The Relationship between Premature Luteinization and Use Different Ovulation Induction Drugs in PCOS Patients

目的卵泡提前黄素化因孕激素在卵泡发育成熟前提前出现而有可能影响其后的胚胎种植,但目前研究多集中在使用Gn RH激动剂/拮抗剂降调的COS周期,对诱发排卵(IO)周期及其促排药物的研究较少,故本文选择PCOS促排卵+IUI患者进行研究,以了解IO周期不同促排卵药物与PL发生的关系。方法收集2016年6月至2017年6月于中山市人民医院生殖中心行IUI的PCOS患者78例,按不同促排卵药物分为克罗米酚组38例、来曲咗组40例,选取无排卵障碍行自然周期+IUI患者34例为对照组,比较三组PL的发生、卵泡发育指标及妊娠率。结果两组PCOS患者年龄、不孕年限、体重指数差异均无统计学意义(P>0.05);促排卵组PL的发生率低于自然周期组,HCG日雌二醇水平及妊娠率高于自然周期组,差异均有统计学意义(P<0.05);两促排卵组之间上述指标比较差异无统计学意义(P>0.05)。结论诱发排卵周期及自然周期仍有PL发生,诱发排卵可降低PL的发生率,结合促排卵周期提高雌二醇水平及成熟卵泡数,可有效提高妊娠率,但不同促排卵药物与PL的发生无关。

Objective Premature luteinization（PL）will cause pregestrone elevated before follicle maturation,the latter may influence succedent embryo implantation.Though most of the research are focus on the controlled ovarian hyperstimulation cycles ues Gn RH analogues, rare research focus on the induced ovarian cycles and the different ovulation induction drugs,so we choose PCOS patients who need ovulation induction and IUI in order to know the relationship between PL and use different ovulation induction drugs in PCOS patients. Method Collected 78 patients during 2016.6-2017.6,according to use different ovulation induction drugs,these patients are divid into Clomiphene group and Letrozole group,the controlled group are choosed infertility patients without ovulatory disorder who need IUI to help pregnancy, compared the incidence rate of PL,follicle development index and pregance rate among these groups. Result There is no statistical difference among age, infertile years,BMI between two ovarian induced groups of PCOS patients;the incidence rate of PL in ovulation induced group is lower than natural cycles group,estradiol level of HCG trigger day and pregnancy rate are higher than natural cycles group, difference are statistically significant; above indexes between two ovarian induced groups has no statistical difference. Conclusion PL will occur either induced ovarian cycle or natural cycle, but there is lower incidence rate in induced ovarian cycle, adding high estradiol level and more mature follicles, induced ovarian will improve pregnancy rate effectively, but there is no difference between different ovulation induction drugs and occurrence of PL.