不同剂量来曲唑联合人绝经期促性腺激素对多囊卵巢综合征患者促排卵治疗妊娠结局的比较

Comparison of pregnancy outcome of PCOS patients who has been receiving ovulation induction by HMG combined with different dosage of letrozole

目的比较不同剂量来曲唑(letrozole,LE)联合人绝经期促性腺激素(human manopausal gonadotropin,HMG)对多囊卵巢综合征(polycystic ovary syndrome,PCOS)患者促排卵治疗的妊娠结局,总结联合促排方案中LE的最佳用药剂量。方法作为前瞻性随机对照研究,利用随机数字表法,将纳入的142例单纯接受LE促排卵无优势卵泡发育的PCOS患者,分为LE 2.5 mg组(n=70)及LE 5.0 mg组(n=72),两组分别于月经第6、8、10天肌肉注射HMG 75 IU。比较两组患者促排卵治疗过程中优势卵泡数目、注射HCG日雌二醇水平、子宫内膜厚度,HMG总用量及临床疗效相关指标的差异。结果两组患者平均年龄、不孕年限、体重指数、D3卵泡刺激素、D3黄体生成素、D3雌二醇水平及D3子宫内膜厚度比较,差异无显著性(P>0.05);接受联合促排卵治疗后,两组患者14~18 mm卵泡数、排卵率、HCG日子宫内膜厚度、生化妊娠率、多胎妊娠率、流产率、取消周期率及OHSS发生率相比,差异无显著性(P>0.05);LE 5.0 mg联合HMG组≥18 mm卵泡数、HCG日E2水平、HMG用量及使用天数均高于LE 2.5 mg联合HMG组,差异有显著性(P<0.05);与LE 2.5 mg联合HMG组相比,LE 5.0 mg联合HMG组的临床妊娠率呈增高趋势,差异无显著性(P>0.05)。结论单纯接受LE治疗无优势卵泡发育的PCOS患者行LE联合HMG方案时,LE的剂量选择5.0 mg/d更加适宜。

Objective To compare the pregnancy outcome of patients with PCOS who has been receiving ovulation induction by HMG combined with different doses of LE, and to summarize the best dosage of LE in the combined ovulation induction scheme. Method This is a prospective and randomized cotrolled study. 142 PCOS patients who showed no dominant follicular after the ovulation of LE were randomly included by using the random number table, and were divided into group LE 2.5 mg(n=70) and group LE 5.0 mg(n=72). The number of dominant follicles, E2 level on the day of HCG injection, endometrial thickness on the day of HCG injection, HMG usage and clinical outcome related indicators were copared. Results There is no significant difference in age, duration of infertility, BMI, D3 FSH, D3 E2 and D3 endometrial thickness between the two groups(P>0.05). During the process of ovulation induction, there is no significant difference in the number of 14-18 mm follicles, the rate of ovulation, endometrial thickness on the day of HCG injection, the rate of biochemical pregnancy, the rate of multiple pregnancy, the rate of miscarriage, the rate of cancelled cycle and the rate of OHSS between the two groups(P>0.05). ≥18mm follicles, E2 levels on the day of HCG injection, dosage of HMG and the days of using HMG is higher in group LE 5.0 mg than group LE 2.5 mg, and the difference is statistically significant(P<0.05). Compared to group LE 2.5 mg, group LE 5.0 mg shows an increasing trend in the rate of clinical pregnancy, although the difference is not statistically significant(P>0.05). Conclusions PCOS patients who showed no dominant follicular after the ovulation of LE only should receive ovulation induction by HMG combined LE, and the appropriate choice of the dosage of LE should be 5.0 mg/d rather than 2.5 mg/d.