不同剂量来曲唑联合低剂量HMG治疗多囊卵巢综合征不孕患者的临床效果

Clinical effect of different doses of Letrozole combined with low-dose HMG on infertile patients with polycystic ovary syndrome

目的分析不同剂量来曲唑联合低剂量尿促性腺激素(HMG)对多囊卵巢综合征(PCOS)不孕症患者的临床治疗效果,为患者的临床促排卵方案提供指导。方法选择2018年1月至2020年12月南方医科大学附属深圳市妇幼保健院生殖医学中心进行常规促排卵治疗的189例PCOS不孕患者为研究对象。依据随机数字表法将患者分为A组(来曲唑2.5 mg)、B组(来曲唑5.0 mg)、C组(来曲唑7.5 mg),月经第2~5天口服来曲唑,5 d后,肌内注射HMG(75 IU/d)。观察并比较各组人绒毛膜促性腺激素(HCG)日促黄体生成素(LH)、雌二醇(E2)、睾酮(T)水平;卵泡成熟天数、HMG使用剂量及使用天数、卵泡发育数量、子宫内膜厚度及临床妊娠、流产、生化妊娠、卵巢过度刺激综合征(OHSS)、多胎妊娠者占比。结果三组HCG日子宫内膜厚度、最大卵泡直径比较,差异无统计学意义(P>0.05)。B、C组卵泡成熟天数、HMG使用天数长于A组,HMG使用剂量低于A组,HCG日≥18 mm卵泡数及≥15 mm卵泡数多于A组,差异有统计学意义(P<0.05)。三组HCG日LH、T水平比较,差异无统计学意义(P>0.05);B、C组HCG日E2水平高于A组,差异有统计学意义(P<0.05)。三组均未发生OHSS;三组临床妊娠、多胎妊娠、流产、生化妊娠者占比比较,差异无统计学意义(P>0.05)。结论不同剂量的来曲唑联合低剂量HMG均能有效改善PCOS排卵障碍患者的卵泡生长发育。PCOS不孕患者在月经期第2~5天开始口服来曲唑5.0 mg,5 d后,联合使用HMG,治疗效果满意,促排卵天数短,OHSS发生率低,临床妊娠率高,具有较高的临床应用价值。

Objective To explore the effect of different doses of Letrozole combined with low-dose human menopausal gonadotropin(HMG)on infertile patients with polycystic ovary syndrome(POCS),and to provide guidance for clinical ovulation promotion programs of patients.Methods A total of 189 infertility patients with PCOS who were received routine ovulation induction treatment in Reproductive Center,the Affiliated Shenzhen Maternity and Child Healthcare Hospital,Southern Medical University from January 2018 and December 2020 as research subjects.They were divided into group A(Letrozole 2.5 mg),group B(Letrozole 5.0 mg),and group C(Letrozole 7.5 mg).After five days of Letrozole oral administration from two to five days of menstruation,HMG was intramuscular injected.The levels of luteinizing hormone(LH),estrdiol(E2),and testoserone(T)in each group on human chorionic gonadotrophin(HCG)day;number of follicular maturation days,doses and days of HMG,number of follicular development,endometrial thickness,and the proportion of patients with clinical pregnancy rate,number of miscarriages,number of biochemical pregnancies,number of ovarian hyperstimulation syndrome(OHSS),and number of multiple pregnancies were observed and compared.Results There were no significant differences in endometrial thickness and maximum follicular diameter among three groups on HCG days(P>0.05);the number of follicular maturation days and days of HMG in groups B and C were longer than those in group A,the doses of HMG were lower than those in group A,and the number of follicles≥18 mm and≥15 mm in HCG days were more than those in group A,and the differences were statistically significant(P<0.05).There were no significant differences in LH and T levels among three groups in HCG days(P>0.05);E2 levels of HCG days in group B and C were higher than those in group A,and the differences were statistically significant(P<0.05).No OHSS occurred in three groups.There were no significant differences in the proportion of patients with clinical pregnancy,multiple pregnancies,miscarriages,and biochemical pregnancies among three groups(P>0.05).Conclusion Different doses of Letrozole combined with low-doses of HMG can effectively improve follicular growth and development in patients with PCOS ovulation disorder.In PCOS infertile patients,Letrozole 5.0 mg is taken orally from the two to five days of menstruation for five days,after five days,combined with HMG,the treatment effect is satisfactory,the number of ovulation induction days is short,the incidence of OHSS is low,and the clinical pregnancy rate is high,which had high clinical application value.