复方口服避孕药预处理对性激素异常的PCOS患者促排卵效果的影响

Effect of combined oral contraceptive preconditioning on ovulation induction in PCOS patients with abnormal sex hormones

目的探讨性激素异常的多囊卵巢综合征(PCOS)患者促排前复方口服避孕药预处理的应用价值。方法选取2019年6月~2021年12月某院108例高雄激素和/或高LH的PCOS患者,随机分为两组,预处理组以复方口服避孕药(COC)降雄激素治疗,激素降至正常后再促排卵,对照组不进行降雄激素预处理。比较两组促排效果、促排用药区别、薄型内膜发生率、妊娠率、妊娠结局等指标。结果预处理组经COC处理后血清LH、睾酮下降,两组排卵率、促性腺激素使用率及平均用量、不良妊娠发生率差异均无统计学意义。预处理组活产率(24.7%)高于对照组(14.7%),差异有统计学意义(P<0.05);临床妊娠率(27.2%)高于对照组(17.9%),薄型内膜发生率(17.9%)也高于对照组(10.5%),但差异无统计学意义。对可能影响活产率的因子进行相关性分析,发现年龄是不利因素,COC预处理及促排前一周期使用孕激素是有利因素。结论性激素异常PCOS患者,COC预处理可改善促排效果,促排前一周期孕激素转化内膜,有利于更好的妊娠结局。

Objective To explore the application value of compound oral contraceptive pretreatment for PCOS patients with abnormal sex hormones.Methods From June 2019 to December 2021,108 PCOS patients with hyperandrogenism and/or high LH in our hospital were randomly divided into two groups.The pretreatment group was treated with compound oral contraceptive(COC)for androgen reduction,and then ovulation was promoted after the hormones decreased to normal,while the control group was not.The ovulation induction effect,the difference of ovulation induction drugs,the incidence of thin endometrium,pregnancy rate and pregnancy outcome were compared between the two groups.Results After COC treatment,serum LH and testosterone in the pretreatment group decreased significantly.There was no significant difference in ovulation rate,gonadotropin usage rate and average dosage,and the incidence of adverse pregnancy between the two groups during ovulation promotion.The live birth rate of the pretreatment group(24.7%)was higher than that of the control group(14.7%),with statistical significance(P<0.05).The clinical pregnancy rate(27.2%)was higher than that of control group(17.9%),and the incidence of thin endometrium(17.9%)was also higher than that of the control group(10.5%),but the difference was not statistically significant.The correlation analysis of the factors that may affect the live birth rate shows that age is the unfavorable factor,while the pretreatment of COC and the use of progesterone in the previous cycle of ovulation promotion are the favorable factors.Conclusion For PCOS patients with abnormal sex hormones,COC pretreatment can improve the effect of ovulation induction,and the use of progesterone to transform endometrium in the previous cycle of ovulation induction is beneficial to better pregnancy outcome.