国产人绝经期促性腺激素-人绒毛膜促性腺激素诱发排卵的临床应用

Induction of ovulaton with domestic hMG-hCG

应用国产人绝经期促性腺激素(HMG)治疗52例长期无排卵者,其中缺乏内源性雌激素活动者28例,有内源性雌激素活动的各种月经紊乱者24例:共100个周期。采用宫颈评分及 B 超监测卵泡发育,98％的周期卵泡成熟。以改变 HMG 剂量的方法促使卵泡生长,结果使卵泡生长到成熟的期限接近自然排卵周期。当优势卵泡>18mm、宫颈评分>8分2天以上时,根据卵巢大小应用不同剂量的人绒毛膜促性腺激素(hCG)或促黄体生成素释放激素(LHRH)诱发排卵。结果 hCG 的排卵率为98.8％,各剂量排卵率无差别;LHRH 排卵率为25％(P<0.01)。妊娠26例,其中流产5例,卵巢过度刺激征(OHSS)发生率41％(41/100),其中重度Ⅰ级6.0％,Ⅱ级1.0％。本文分析了适应证及用药方法与疗效的关系、发生 OHSS 的高危因素及 OHSS 与妊娠及流产的关系,提出了结合国内监测条件,提高疗效,避免 OHSS 的合理用药方法。

Domestic products of human menopausal go- nadotropin(HMG) and human chorionic gonadotropin (hCG) were used in the treatment of 100cycles in 52 infertile patients with long-term anovulation.Among the 52 cases,28 with amenorrhea and low endogenous estrogen level,while the other 24 with various men- strual disorders showed evidence of endogenous estro- gen activity.The dosages of HNIG were adjusted ac- cording to the ovarian responses monitored the cervi- cal score(CS) and ultrasound estimation of the size of the follicle with reference to that of the maturai cy- cles.When the follicle reached≥18mm and the CS >8 for more than 2 days and with reference to the size of the ovary,different doses of hCG or LHRH were used for induction of ovulation.Results showed that the rate of follicle maturity was 98% among the 100 HMG-stimulated cycles.The rate of ovulation in- duction with hCG was 98.8% and with LHRH was 25%(P<0.01).26 patients conceived,5 aborted (19.2%).The rate of ovarian hyperstimulation syn- drome(OHSS) was 41%,grade I severe 6.0% and grade Ⅱ 1.0%.The relationships between indication, therapeutic regimen and results were discussed.High risk factors that will predispose to OHSS and the in- fluence of OHSS on pregnancy were analysed.In or- der to improve the therapeutic effect and prevent OHSS,some methods of HMG/hCG use were recom- mended.