克罗米芬加补佳乐治疗排卵障碍性不孕症107例

Effects of clomiphene citrate plus progynova on unovulation

目的 :探讨克罗米芬 (clomiphenecitrate ,CC)加用补佳乐 (progynova ,PGV)对排卵障碍性不孕症的治疗效果 .方法 :将 1 0 7例排卵障碍性不孕症患者随机分为 3组 ,CC组 36例 ,单纯给予克罗米芬治疗 ;CC +PGV组 38例 ,给予克罗米芬加补佳乐治疗 ;人绝经期促性腺激素 (humanmenopausalgo nadotropin ,HMG)组 33例 ,给予HMG治疗 .利用超声波观察促排卵周期不孕症患者的子宫内膜厚度、类型、成熟卵泡数 ,妇科检查行宫颈评分 ,使用ELISA检测雌二醇 (estradiol,E2 )、孕激素 (progesterone,P)的浓度 ,进行比较 .结果 :CC +PGV组和HMG组在围排卵期子宫内膜厚度及宫颈评分分别为 (1 1 .8±2 .3)和 (1 1 .2± 1 .8)mm ,(1 0 .8± 0 .9)和 (1 0 .2± 1 .6 ) ,显著高于CC组 (8.2± 1 .2 )mm ,(8.7± 1 .5 ) (P <0 .0 1 ) ;3组子宫内膜类型 (A或B型 )比较无显著性差异 (P >0 .0 5 ) ;HMG组成熟卵泡数及黄体成熟期P浓度分别为 (5 .3± 1 .5 )和 (1 6 .7± 2 .4 )μg·L-1 ,明显高于CC组和CC +PGV组 [(3.9± 0 .8)和 (1 2 .9±0 .8) μg·L-1 ],[(3.1± 1 .7)和 (1 4 .6± 1 .7) μg·L-1 ](P <0 .0 1 ) ;HMG组E2 浓度为 (5 5 9± 1 87)ng·L-1 明显高于CC组 (1 89± 73)ng·L-1 、CC +PGV组 (2 2 6± 1 0 7)ng·L-1

AIM: To investigate the combined effects of clomiphene citrate (CC) and progynova (PGV) on the unovulation. METHODS: 107 unovulation patients were randomly divided into 3 groups, among whom 36 cases were given only CC; 38 cases were given CC+PGV and 36 cases were given human menopausal gonadotropin (HMG). All of the patients had transvagial ultrasound examination to identify the endometrium thickness, type and matured follicles. Physical examination was performed to record uterocervical score and ELISA was used to determined the concentrations of serum estradiol (E 2) and progesterone (P). RESULTS: In the periovulation phase, the endometrium thickness and the uterocervical score of CC+PGV group and HMG group were [(11.8±2.3) mm, ( 10.8 ±0.9)] and [(11.2 ±1.8) mm ,(10.2±1.6)], while those of CC group were [(8.2±1.2) mm, (8.7± 1.5 )], obviously lower than those of other groups( P < 0.01 );There was no difference of endometrium type among the three groups. The number of matured follicles and the concentration of P at the maturate of corpus luteum in HMG group were [(5.3±1.5) and (16.7±2.4) μg·L -1 ], much higher than those in CC and CC+PGV groups [(3.9±0.8), (3.1±1.7) and (12.9±0.8) μg·L -1 , (14.6± 1.7 ) μg·L -1 ] ( P <0.01). The concentration of the E 2 in HMG group was [(559±187) ng·L -1 ], obviously higher than that in CC and CC+PGV groups [(189±73) ng·L -1 and (226±107) ng·L -1 ]( P <0.01). The pregnancy rates of the three groups were 11.1%, 31.6% and 39.4%, respectively and the pregnancy rates of CC+PGV and HMG groups were significantly higher than that of CC group( P <0.05, P <0.01). Ovarian hyperstimulation syndrome (OHSS) cases in the CC, CC+PGV and HMG groups were 0, 0 and 2, respectively and the incidence of miscarriage was 2, 2 and 1. CONCLUSION: Administration of clomiphene citrate plus progynova can improve the pregnancy rate, which has the similar effects to human menopausal gonadotropin in clinical treatment.