Usefulness of Newly Devised Clomiphene Citrate Administration Method Compared with the Conventional Method in Ovulation and Pregnancy

Objective: Since not all women wish to conceive a child through aggressive treatment, we investigated the usefulness of modified repeated intracyclic clomiphene citrate (CC) therapy (repeated CC therapy) as a newly devised administration method. Methods: We evaluated the effects of CC administration on menstrual cycle length and retrospectively compared ovulation and pregnancy in 220 women who received CC at our hospital. Patients in the conventional method group received 50 mg per day for five days, starting on the fifth day of menstruation (withdrawal bleeding). Groups with and without menstrual cycle shortening after conventional CC administration were compared. The repeated CC therapy group was also compared with the non-shortened group. Repeated CC therapy was administered for the first five days as in the conventional method, and a second five-day repeat treatment was administered after an interval of five to seven days. Pregnancy rates, including indirect pregnancies, were evaluated by three different methods. Results: Ovulation and pregnancy rates were significantly better in the shortened group than in the non-shortened group (P < 0.001 and P = 0.010, respectively). Even in the non-shortened group, ovulation and pregnancy rates including indirect pregnancies were significantly improved when ovulation was observed with repeated CC therapy (P < 0.001 and P = 0.022, respectively). Conclusions: For patients whose menstrual cycle was not improved or shortened, repeated CC therapy as the newly devised CC administration method is useful as the next step after the conventional CC administration method.

Clomiphene Citrate Induces ROS-Mediated Apoptosis in Mammalian Oocytes

The clomiphene citrate (CC), a nonsteroidal triphenylethylene compound, is a first line of medicine used for the induction of ovulation in anovulatory women worldwide. In spite of high ovulation induction with the use of CC, the pregnancy rate is much lower. Such a discrepancy could be due to the peripheral anti-estrogenic effect of CC, particularly at the level of ovary, endometrium and cervical mucus. CC induces ovulation by binding to the estrogen receptors and generates hypoestrogrnic state in hypothalamus leading to release of pituitary gonadotropins. CC may have a direct effect at the level of ovary but the molecular mechanism remains unclear. Animal studies suggest that the CC induces apoptosis in granulosa cells and results hypoestrogenic state in the ovary. Reduced estradiol 17β level in the ovary affects development and maturation of oocyte leading to oocyte apoptosis. Further, CC increases hydrogen peroxide (H2O2) level and thereby bax protein expression and DNA fragmentation in cumulus-granulosa cells as well as in oocytes. The exogenous supplementation of either estradiol 17β or melatonin reduces H2O2 level in ovary, delays meiotic cell cycle progression in oocyte and protects oocyte apoptosis. Hence, supplementation of estradiol 17β or melatonin along with CC could be beneficial to protect granulosa cell as well as oocyte apoptosis and inhibit deterioration of oocyte quality. Thus, maintenance of oocyte quality may overcome the adverse effect caused due to CC treatment during infertility management.

Randomized controlled trial of Letrozole versus Clomiphene citrate for induction of ovulation in polycystic ovarian syndrome (PCOS): A Malaysian experience

Background: The purpose of this study was to compare the effectiveness of Letrozole versus Clomiphene citrate for ovulation induction in polycystic ovarian syndrome (PCOS) with infertility. Methods: This was a prospective randomized trial involving 150 women with PCOS attending the Infertility Clinic at three hospitals in Malaysia. During the initial visit, anthropometric measurements and baseline investigations were performed. Patients were randomized to 5.0 mg Letrozole daily (75 patients) or 100 mg Clomiphene citrate daily (75 patients) from the fifth until the ninth day of menstruation. Serial transvaginal scans were performed to see the dominant follicles, endometrial thickness and number of follicles. Transvaginal scans were performed serially to look for evidence of ovulation. Results: The subjects were homogenously distributed. The difference between Letrozole and Clomiphene citrate for ovulation rate was 59 (78.7%) versus 40 (53.3%). Patients taking Letrozole exhibited a mean endometrial thickness (ET) at mid cycle of menses (Day 11-D14) of9.2 mm(SD ± 2.3) versus8.4 mm(SD ± 2.2) for patients taking Clomiphene citrate, and these differences were statistically significant

Simultaneous Letrozole and Clomiphene Citrate versus Letrozole Alone in Clomiphene Citrate Resistant Polycystic Ovary Syndrome: A Randomised Controlled Trial

Background: Polycystic ovary syndrome (PCOS) is a common cause of anovulatory infertility. The therapeutic strategies for clomiphene citrate (CC)- resistant patients include the addition of corticosteroids, extended duration of clomiphene, gonadotrophin therapy, laparoscopic ovarian drilling, in vitro fertilization or the use of aromatase inhibitors recently. Letrozole decreases estrogen levels in the body, so it releases the hypothalamus and/or pituitary gland from the negative feedback of estrogen. This increases levels of gonadotrophins, which stimulates follicular growth. Objectives: To evaluate the role of letrozole alone and simultaneous use of letrozole and clomiphene citrate (CC) for ovulation induction in patients with clomiphene citrate-resistant PCOS (CCR-PCOS). Patients and Methods: This open-label randomised controlled study was conducted in the Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Egypt during the period from February 2018 to June 2019. The study included 60 CCR-PCOS patients who were randomly allocated by independent personnel into two arms: group A (letrozole alone) or B (letrozole + CC). In either group, monitoring the mean follicular diameter and endometrial thickness in the days 10, 12, and 14 of the cycle by transvaginal ultrasound and Measurement of serum Progesterone (ng/ml) 7 days after the expected time of ovulation. Results: We investigated various clinical and sonographic factors that may predict the outcome of the method of induction of ovulation in CCR-PCOS with no significant affection for the results. There was a non-significant difference between the studied groups regarding ovulation and pregnancy per cycle or per patient. Conclusion: Letrozole alone or simultaneous use of letrozole and CC offers a good second-line option for induction of ovulation in CCR-PCOS patients. However, the combination of CC and letrozole did not add any benefit over the use of letrozole alone regards ovulation rate, follicular volume, endometrial thickness, pregnancy rate and live birth rate.

Physicians’ Attitude toward the Use of Metformin Prior to Clomiphene Citrate in Infertile Women with PCOS in Saudi Arabia

The goal of this study is to assess the different approaches gynecologists take while treating women with PCOS related infertility. Methodology: This is a quantitative cross-sectional study that involves 46 specialists and consultants from all over the kingdom of Saudi Arabia. The sample size was calculated based on the number of consultants and specialists members in the Saudi Obstetrical & Gynecology society “SOGS”, we could not find any statistics on how many Ob/Gyne doctors we have in Saudi Arabia. The paper is approved by the Unit of Biomedical Ethics, King Abdulaziz University. The research team prepared an online survey of 13 questions, sent to all Consultants and Specialists in the “SOGS” during the year of 2016. The SPSS was used for the analysis. Conclusion: There is no significant difference between the different approaches of the first line of management. Comparing between Metformin and Clomiphene Citrate, Thirty Seven percent of participants preferred to start by a combination while 32% preferred to start with the former and 30.4% with the latter. Most of the doctors preferred to use Metformin for the Obese patients 76.1%, a lower percentage prefers to use it with Overweight patients 54.3%.

Bilateral Retinal Detachment Secondary to Clomiphene Citrate

Purpose: The purpose of this study is to assess the relationship between Clomifene citrate and retinal detachment in particular. Methods: a 42-year-old woman has developed bilateral retinal detachment after three courses of clomiphene citrate. A literature research for bilateral retinal detachment does not include this severe ophthalmologic complication. Conclusion: This is the first reported case of bilateral retinal detachment after treatment with clomiphene citrate. The caution is warranted in treating infertility patients with CC, and patient should be well informed of this side effect before prescribing this therapy by gynecologist.

Letrozole versus Gonadotropin in Unexplained Infertile Couples Failed to Conceive with Clomiphene Citrate

Background:?Unexplained infertility represents about 15% - 20% of infertile couples. Usually, these cases need assistance. Clomiphene citrate is the most used drug for this problem but sometimes pregnancy failed to achieve it, so other options for assistance are gonadotrophin or letrezole. The objective of our study was to compare the pregnancy rate for letrezole and gonadotropin inunexplained infertile women’s who failed to conceive with clomiphene citrate. Methods: This prospective quasi-randomized trial was carried out in cytogenetic unite at obstetrics and gynecology department, Zagazig University Hospital. 140 infertile females were included, induction of ovulation by letrozole for half of them and by gonadotrophin for the other half. Results: There was statistically highly significant decrease in duration of stimulation, E2 levels and endometrial thickness at day of HCG in letrezole group, no significant difference between two groups as regard number of follicles and pregnancy rate per cycle, while the cumulative pregnancy rate and the cost of stimulation are significantly higher in gonadotrophin group. Conclusion: In patient with unexplained infertility who failed to conceive with clomiphene citrate, gonadotrophins have a higher pregnancy rate than letrezole. However, pregnancy rate was high enough with lower cost with letrezole to be acceptable and justified its use in this group of patients.

A meta-analysis on the improvement of endometrial receptivity of PCOS by Bushen recipe combined with Clomiphene

Objective: To systematically evaluate the efficacy and safety of Bushen Recipe combined with clomiphene compared with clomiphene in improving endometrial receptivity of polycystic ovary syndrome. Methods: The time limit is from the establishment of the database to January 2, 2020. A randomized controlled trial was conducted to compare the effects of Bushen Recipe combined with clomiphene and clomiphene on the endometrial receptivity of polycystic ovary syndrome (PCOS). Meta analysis was performed with RevMan5.3 software. Results: A total of 13 RCTS were included, with a total of 797 PCOS patients. The results of this meta-analysis show: there were statistically significant differences in the improvement of endometrial thickness [WMD=1.62,95%CI(1.22, 2.01), P <0.00001], endometrial type[RR=1.51,95%CI(1.28, 1.78), P <0.00001], uterine artery pulse index(PI) [WMD=-0.18,95%CI(-0.27, -0.09) , P <0.0001], uterine artery resistance index(RI)[WMD=-0.08,95%CI(-0.11, -0.05) , P <0.00001], pregnancy rate [RR=2.18,95%CI(1.55, 3.05), P <0.00001], TCM syndrome score[WMD=-6.97,95%CI(-8.97, -4.97) , P <0.00001], effective rate [RR=1.25, 95%CI (1.13, 1.37), P < 0.00001]. Conclusion: Compared with clomiphene alone, Bushen Recipe combined with clomiphene can effectively increase the thickness of endometrium and improve the type of endometrium, promote the blood perfusion of endometrium, improve the pregnancy rate, improve the clinical symptoms, reduce the TCM syndrome score, improve the total efficiency of treatment, with high clinical application value.

The advantage of low-dose clomiphene citrate for overweight women with anovulation

Background:To investigate the potential advantage of using low-dose clomiphene citrate to promote ovulation in women with overweight or obesity.Methods:The patients with overweight were divided randomly into regular clomiphene citrate group(clomiphene citrate 50 mg/d,n=83)and low-dose clomiphene citrate group(clomiphene citrate 25 mg/d,n=105).All patients received treatment from the 5th day of their menstrual cycles.Results:Luteinizing hormone levels and estradiol levels were more increased in the low-dose group compared with the regular group(P<0.05).Low-dose group showed significantly thicker endometrium,fewer dosage and shorter days of human menopausal gonadotropin,less numbers of mature follicles and lower rates of cancellation(P<0.05)on human chorionic gonadotropin day.After human chorionic gonadotropin injection,the ovulation rate in the low-dose group was significantly higher than the regular group(P<0.05).No difference was detected in the biochemical pregnancy rates both groups(P>0.05).Conclusion:The low-dose clomiphene citrate treatment significantly reduced the number of mature follicles and increased the thickness of endometrium on the human chorionic gonadotropin day with less side effects.The low-dose clomiphene citrate also achieved the better ovulation rate.

Effects of acupoint embedding combined with clomiphene in patients with polycystic ovary syndrome： a randomized controlled trial

Objective： To compare the efficacy of acupoint embedding combined with clomiphene with clomiphene alone in the treatment of patients with polycystic ovary syndrome （PCOS）. Methods： Sixty patients who met the diagnostic criteria of PCOS were randomly divided into the acupuncture-medicine combination （30 cases） and the single medicine （30 cases） groups. For a total of 4 menstrual cycles, patients in the acupuncture-medicine combination group were treated with acupoint embedding combined with oral clomiphene, whereas those in the single medicine group were treated with clomiphene only. Clinical efficacy of the two treatments was observed after 2 months of treatment, and body mass index （BMI）, number of menstrual cycles, luteinizing hormone （LH）, follicle stimulating hormone （FSH）, LH / FSH ratio, and serological levels of testosterone before and after treatment were analyzed. Results： Compared with the single medicine group, patients in the acupuncture-medicine group showed lower BMI （24.3 ± 1.6 vs 26.1 ± 1.8） and higher number of menstrual cycles （3.6 ± 1.5 vs 2.8 ± 1.2）; the differences were statistically significant （P = 0.018, P = 0.025）. LH （9.53 ± 5.46 vs 12.29 ± 5.67） and LH / FSH （1.02 ± 0.57 vs 1.45 ± 0.23） levels were significantly decreased （P = 0.041, P = 0.039）. Compared to before treatment, BMI （24.3 ± 1.6 vs 27.6 ± 1.4） was lower and the number of menstrual cycles was higher （3.6 ± 1.5 vs 1.8 ± 0.8） after treatment; the differences were statistically significant （P = 0.034, P = 0.024）. The levels of LH （9.53 ± 5.46 vs 18.12 ± 11.04） and LH / FSH （1.02 ± 0.57 vs 2.38 ± 1.09） were significantly decreased （P = 0.007 P = 0.005）. Total effective rates were 76.67% and 70% in the acupuncture-medicine combination and single medicine groups, respectively; the difference between the two groups was statistically significant （P = 0.043）. Conclusion： Acupoint embedding combined with clomiphene in the treatment of PCOS could downregulate BMI, LH, and LH / FSH ratio, and increase the number of menstrual cycles.

Effect of metformin combined with clomiphene on insulin resistance, oxidative stress response and T cell immune response in patients with PCOS

Objective: To study the effect of metformin combined with clomiphene on insulin resistance, oxidative stress response and T cell immune response in patients with polycystic ovarian syndrome (PCOS). Methods: A total of 94 patients who were diagnosed with PCOS in Jingzhou Second People's Hospital between September 2014 and October 2016 were selected and randomly divided into the combined group who received the metformin combined with clomiphene therapy and the control group who received clomiphene therapy. The insulin resistance, oxidative stress response and T cell immune response were evaluated before treatment and 3 menstrual cycles after treatment. Results: 3 menstrual cycles after treatment, HOMA-IR level, serum F-Ins, F-CP, TOS, MDA, AOPP and IL-17 contents as well as peripheral blood RORγt mRNA expression of combined group were significantly lower than those before treatment while HOMA-β level, serum TAS, SOD, GSH-Px, VitC, VitE, IL-10 and TGF-β1 contents as well as peripheral blood Foxp3 mRNA expression were significantly higher than those before treatment;HOMA-IR and HOMA-β levels, serum F-Ins, F-CP, TOS, MDA, AOPP, IL-17, TAS, SOD, GSH-Px, VitC, VitE, IL-10 and TGF-β1 contents as well as peripheral blood Foxp3 and RORγt mRNA expression of control group were not different from those before treatment. Conclusion: Metformin combined with clomiphene can significantly improve the insulin resistance, oxidative stress response and T cell immune response in patients with PCOS.

Acupuncture-induced improvement of endometrial receptivity of rats with polycystic ovary syndrome treated by Clomiphene for ovarian stimulation

Objective To observe acupuncture effects on endometrial receptivity of the rats with polycystic ovary syndrome （PCOS） treated by ovarian stimulation with Clomiphene to explore its mechanisms. Methods eGOS rat model was experimentally induced by subcutaneous injection of oil solution of dehydroepiandrosterone （DHEA） in immature （24-day-old） female rats for continuous 20 days. The same dose of oil was given for an equivalent length of time to animals in a control group （Group Con）. The rats with PCOS were randomly divided into a model group （group M）, a Clomiphene treatment group （group C）, a Clomiphene plus acupuncture group （group C＋ A）. The treatments were given for 5 days since 80 days after birth. Half of the rats were killed by decapitation after treatment finished, and the serum, uteri and endometria were obtained. The other half mated with male rats, and they were killed at the 8th day of pregnancy. We observed the implantation number and condition of pregnant uteri. Results Compared with group C, the animals in group C＋A had higher implantation rate and more average implanted embryos （P〈0. 01 ）, higher serum estradiol （E2） level （P〈0.01 ）, better development of endometrium, and increased mRNA and protein expressions of molecular markers of endometrial receptivity （P〈0.01）, which were closer to those in the control group. Conclusion Acupuncture could improve poor endometrial receptivity of PCOS rats with ovarian stimulation by citrated Clomiphene and promote implantation. The effects may be related with its up-regulation of serum E2 level, mRNA and protein expressions of molecular markers of endometrial receptivity.

亚精胺对人子宫内膜基质细胞自噬和炎症细胞因子表达的影响

目的:探讨克罗米芬(CC)对子宫内膜基质细胞(hEndoSCs)的损伤作用,并研究亚精胺对受损子宫内膜基质细胞自噬和炎症细胞因子表达的影响。方法:实验分为对照组、亚精胺组、克罗米芬组(CC组)、CC+亚精胺组。MTT法检测hEndoSCs与不同浓度CC或亚精胺共同孵育24 h后细胞的存活率;流式细胞技术检测4组细胞内活性氧(ROS)含量和细胞凋亡水平。Western blot检测自噬途径相关蛋白ULK1、p-ULK1、LC-3Ⅱ和凋亡相关蛋白Bax、Bcl-2、Cleaved-caspase 3的表达。采用RT-qPCR检测IL-6、IL-1β、TNF-αmRNA表达量。结果:与对照组相比,CC组细胞存活率下降,细胞凋亡率、ROS含量、Bax、Cleaved-caspase 3表达量升高,Bcl-2表达量降低,自噬相关蛋白p-ULK1、LC-3Ⅱ/Ⅰ水平降低,炎症因子IL-6、IL-1β、TNF-αmRNA表达升高(P<0.01)。与对照组相比,亚精胺组细胞的存活率无明显变化(P>0.05)。与CC组相比,CC+亚精胺组细胞存活率显著提高,细胞凋亡率、ROS含量、Bax和Cleaved-caspase 3表达量降低,Bcl-2表达量升高,自噬相关蛋白p-ULK1、LC-3Ⅱ/Ⅰ表达升高,炎症因子IL-6、IL-1β、TNF-αmRNA表达降低(P<0.01)。结论:CC能够抑制子宫内膜基质细胞增殖,促进细胞凋亡,提高炎症因子IL-6、IL-1β、TNF-α的转录水平。亚精胺可通过激活细胞自噬,降低CC损伤的子宫内膜基质细胞胞内ROS水平,提高细胞存活率,并抑制炎症因子IL-6、IL-1β、TNF-α表达。

炔雌醇环丙孕酮片联合枸橼酸氯米芬片治疗多囊卵巢综合征不孕症的效果及对子宫内膜容受性、排卵情况及妊娠的影响

目的探讨炔雌醇环丙孕酮片联合枸橼酸氯米芬片治疗多囊卵巢综合征(PCOS)不孕症的效果及对子宫内膜容受性、排卵情况和妊娠的影响。方法选取2021年3月至2022年3月安徽医科大学附属安庆市第一人民医院收治的90例PCOS不孕症患者作为研究对象。根据随机数字表法分为对照组和观察组,每组45例。对照组单用枸橼酸氯米芬片治疗,观察组在对照组基础上联合炔雌醇环丙孕酮片治疗。比较两组临床疗效、子宫内膜容受性、排卵情况及妊娠结局。结果观察组总有效率高于对照组(P<0.05);治疗后,两组子宫内膜厚度较治疗前均升高,且观察组高于对照组(P<0.05);治疗后,两组血流搏动指数(PI)和阻力指数(RI)较治疗前均减小,且观察组小于对照组(P<0.05);治疗后,观察组成熟卵泡数量较对照组更少(P<0.05);治疗后,两组最大卵泡直径和排卵率比较,差异无统计学意义(P>0.05);随访12个月,观察组临床妊娠率较对照组更高,不良妊娠结局率较对照组更低(P<0.05)。结论采用炔雌醇环丙孕酮片联合枸橼酸氯米芬片治疗PCOS不孕症患者,可显著提升治疗效果,增强子宫内膜容受性,有效促进排卵并改善妊娠结局。

枸橼酸氯米芬+二甲双胍对多囊卵巢综合征不孕症患者的疗效及其性激素水平的影响

目的探究多囊卵巢综合征不孕症的联合疗法,分析枸橼酸氯米芬、二甲双胍联用的价值。方法随机选取滕州市妇幼保健院于2022年3月—2023年6月收治的60例多囊卵巢综合征不孕症患者为研究对象,经信封法分为对照组(n=30,枸橼酸氯米芬治疗)、观察组(n=30,枸橼酸氯米芬+二甲双胍治疗),比较两组性激素、血糖及胰岛功能、排卵率、妊娠率、治疗有效率、不良反应发生率。结果治疗后,观察组性激素、血糖及胰岛功能、排卵率、妊娠率、治疗有效率均优于对照组,差异有统计学意义(P均<0.05);两组不良反应发生率(13.33%vs 10.00%)对比,差异无统计学意义(χ^(2)=0.162,P=0.688)。结论多囊卵巢综合征不孕症联合应用枸橼酸氯米芬、二甲双胍治疗具有显著效果,可有效改善患者的性激素、血糖、胰岛功能、排卵情况及妊娠情况,保障临床治疗安全性。

养阴舒肝胶囊联合枸橼酸氯米芬治疗多囊卵巢综合征性不孕症的临床效果

目的:探讨养阴舒肝胶囊联合枸橼酸氯米芬治疗多囊卵巢综合征性不孕症的临床效果。方法:选取2019年6月—2022年5月沈阳维康医院收治的72例多囊卵巢综合征性不孕症患者作为研究对象,依据随机数字表法将患者分为对照组和治疗组,各36例。对照组应用枸橼酸氯米芬治疗,治疗组给予养阴舒肝胶囊联合枸橼酸氯米芬治疗。比较两组患者临床疗效,性激素[卵泡刺激素(FSH)、雌二醇(E_(2))、促黄体生成素(LH)、雄性激素(MH)]水平,卵巢血流动力学指标[搏动指数(PI)、阻力指数(RI)],妊娠成功情况。结果:两组患者治疗后,治疗组总有效率高于对照组,差异有统计学意义(P=0.041)。治疗后,两组患者LH、MH水平低于治疗前,FSH、E_(2)水平高于治疗前,且治疗组FSH、LH、E_(2)、MH水平改善情况优于对照组,差异有统计学意义(P<0.05)。治疗后,两组患者PI高于治疗前,RI低于治疗前,且治疗组PI、RI水平改善情况优于对照组,差异有统计学意义(P<0.05)。经过1年随访,治疗组妊娠成功率高于对照组,差异有统计学意义(P=0.009)。结论:养阴舒肝胶囊联合枸橼酸氯米芬治疗多囊卵巢综合征性不孕症患者效果显著,能明显改善患者卵巢功能、激素水平,提高妊娠成功率。

调心补肾促排卵汤联合戊酸雌二醇+克罗米芬对排卵障碍性不孕症患者子宫内膜容受性及子宫动脉血流的影响

目的探究调心补肾促排卵汤联合戊酸雌二醇+克罗米芬对排卵障碍性不孕症患者子宫内膜容受性及子宫动脉血流的影响。方法选取2019年6月至2022年8月江阴市中医院收治的120例排卵障碍性不孕症患者作为研究对象。采用随机数字表法分为对照组和联合组,每组60例。对照组采用戊酸雌二醇+克罗米芬治疗,联合组在对照组基础上联合调心补肾促排卵汤治疗。比较两组的疗效、排卵率、妊娠率、A型内膜率、子宫内膜厚度、子宫动脉阻力指数(RI)和搏动指数(PI)。结果与对照组比较,联合组治疗总有效率、排卵率、妊娠率和A型内膜率显著升高,差异具有统计学意义(P<0.05)。治疗后,两组子宫内膜厚度均显著大于治疗前,RI、PI水平均显著低于治疗前,且联合组上述指标优于对照组,差异具有统计学意义(P<0.05)。结论调心补肾促排卵汤联合戊酸雌二醇+克罗米芬可以改善排卵障碍性不孕症患者的子宫内膜厚度、子宫内膜分型和子宫动脉血流指数,提高排卵率和妊娠率。

少精弱精方联合枸橼酸氯米芬和维生素E对少精弱精症患者的临床疗效

目的 考察少精弱精方联合枸橼酸氯米芬和维生素E对少精弱精症患者的临床疗效。方法 102例患者随机分为对照组和观察组,每组51例,对照组给予枸橼酸氯米芬和维生素E,观察组在对照组基础上加用少精弱精方,疗程3个月。检测临床疗效、精液参数(精子存活率、精液量、精子密度、精子向前活动率、a级精子、a+b级精子)、血清性激素(睾酮、黄体生成素、促卵泡生成素)、精液凋亡因子(Caspase-3、Caspase-8)、不良反应发生率变化。结果 观察组总有效率高于对照组(P<0.05)。治疗后,2组精液参数、睾酮升高(P<0.05),黄体生成素、促卵泡生成素、精液凋亡因子降低(P<0.05),以观察组更明显(P<0.05)。2组不良反应发生率比较,差异无统计学意义(P>0.05)。结论 少精弱精方联合枸橼酸氯米芬和维生素E可安全有效地改善少精弱精症患者血清性激素水平,降低精液凋亡因子水平,提高临床疗效、精子质量和活力。

中成药联合枸橼酸氯米芬治疗排卵障碍性不孕症的网状Meta分析

目的:运用网状Meta分析评价不同中成药联合枸橼酸氯米芬(CC)治疗排卵障碍性不孕症的疗效。方法:计算机检索PubMed、荷兰医学文献数据库(EMbase)、Cochrane图书馆(Cochrane Library)、中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)、万方(Wanfang)数据库及维普(VIP)数据库,搜集不同中成药联合CC治疗排卵障碍性不孕症的随机对照试验文献,检索时限均为从建库至2023年2月,运用Stata 16.0进行网状Meta分析。结果:共纳入30篇文献,共2 647例病例,涉及12种中成药。Meta分析结果显示:在改善子宫内膜厚度、提高排卵率、提高妊娠率方面,分别是定坤丹、归脾丸、调经促孕丸联合CC的效果最优。结论:纳入的中成药联合CC治疗排卵障碍性不孕症的疗效均优于单纯使用CC的疗效。由于本研究具有一定局限性,尚需高质量、大样本的随机对照研究加以验证。

来曲唑联合甲泼尼龙治疗克罗米芬抵抗的多囊卵巢综合征不孕患者的临床观察

目的探讨来曲唑联合甲泼尼龙对克罗米芬抵抗的多囊卵巢综合征不孕患者临床结局、卵巢储备功能、血清性激素和安全性的影响。方法回顾性分析青岛市中心医院妇科2021年2月至2022年1月收治的78例克罗米芬抵抗的多囊卵巢综合征不孕患者的临床资料,根据治疗方法不同分为对照组(42例)和观察组(36例)。对照组患者在月经周期第5~9天口服来曲唑5 mg/d,顿服,并采用阴道B超监测子宫内膜和卵泡发育情况、以戊酸雌二醇纠正子宫内膜厚度、以绒促性素诱发排卵等措施促进受孕。观察组患者在对照组治疗基础上,于自然月经或者撤退性出血第3天开始口服甲泼尼龙,4 mg/d,顿服。2组均治疗6个月经周期。比较2组患者排卵和1年内妊娠情况,血清性激素[雌二醇(E2)、黄体生成素(LH)、卵泡刺激素(FSH)、睾酮]、抗米勒管激素(AMH)水平,排卵指标(卵泡生长时间、排卵数量和优势卵泡数量)以及不良反应发生情况。结果治疗后,观察组患者的生化妊娠率(72.22%)和临床妊娠率(47.22%)均显著高于对照组(47.62%、19.05%),血清E2、LH、FSH、睾酮和AMH水平均显著低于对照组,卵泡生长时间显著短于对照组,排卵数量和优势卵泡数量均显著多于对照组(P<0.05)。观察组和对照组患者的排卵率(94.44%vs.83.33%)和不良反应总发生率(8.33%vs.9.52%)比较,差异均无统计学意义(P>0.05)。结论来曲唑联合甲泼尼龙相比单用来曲唑能够显著提高克罗米芬抵抗的多囊卵巢综合征不孕患者的妊娠率,调节其性激素水平,改善其卵巢储备功能,且安全性良好。