FSH传统方案和低剂量缓增方案治疗多囊卵巢综合征无排卵的前瞻性对比研究

多囊卵巢综合征(PCOS)患者无排卵性不孕首选治疗为氯菧酚(CC),排卵率约80％,妊娠率仅25％。CC无效者采用传统的hMG递增方案,6周期累积妊娠率82％。由于多囊卵巢对促性腺激素的高敏性,多卵泡发育,多胎妊娠和卵巢过度刺激综合征(OHSS)发生率高。纯FSH递增方案不能纠正上述缺点。近年报道FSH低剂量缓增方案可能减少这些     

多囊卵巢综合征小剂量促卵泡激素诱导排卵

多囊卵巢综合征(PCOS)引起的无排卵性不育在处理上相当棘手。氯底酚胺(CC)治疗妊娠率低,传统的促性腺激素(Gn)治疗引起多卵泡发育,卵巢     

卵泡穿刺抽吸在治疗多囊卵巢综合不育患者中临床意义初探

目的:探讨卵泡穿刺抽吸对多囊卵巢综合征(PCOS)不孕患者卵巢窦卵泡计数及妊娠的影响。方法:将74例行人绝经期促性腺激素(hMG)促排卵的PCOS患者随机分为二组,观察组37例,于卵泡直径达9-10mm时行卵泡穿刺抽吸;对照组37例,仅行常规促排卵,连续观察6个月,观察穿刺治疗前后性激素FSH、LH、T、E2、PRL水平的变化,比较二组患者卵巢窦卵泡计数及妊娠情况。结果:穿刺抽吸组与治疗前比较,11例患者的血清LH/FSH降低,T、E2、PRL水平无明显变化,29例患者卵巢基础窦卵泡计数降至10个/卵巢以下,无一例发生卵巢过度刺激综合征(OHSS),6个月内14例妊娠;对照组患者的血清性激素水平无明显变化,卵巢基础窦卵泡计数仍为10个/卵巢以上,发生OHSS者3例,6个月内仅3例妊娠。结论:常规治疗无效的PCOS不孕患者,行卵泡穿刺抽吸为有效治疗途径。     

卵泡穿刺配合人工授精治疗多囊卵巢综合征引起的不孕症

目的 了解阴道超声引导下卵泡穿刺后行人工授精治疗多囊卵巢综合征(polycysfic ovary syndrome，PCOS)所致不孕症的效果。方法 选择对克罗米芬治疗无反应的PCOS患者应用促排卵药治疗后，随机选择60例在阴道超声引导下卵泡穿刺后行人工授精术；另选择60例患者直接指导性生活。结果 对照组60例患者临床妊娠率23．33％，卵巢过度刺激综合征(ovarian hyperstimulation syndrome，OHSS)发生率40．00％，卵泡穿刺组60例患者临床妊娠率48．33％，OHSS发生率35．00％。结论 促排卵治疗后，阴道超声引导下卵泡穿刺配合人工授精治疗，提高了PCOS所致的不孕症患者的临床妊娠率，OHSS的发生率未降低。     

多囊卵巢综合征不孕患者未成熟卵泡抽吸术的疗效分析

目的:探讨对克罗米芬抵抗的多囊卵巢综合征(PCOS)不孕患者在超声引导下行小卵泡抽吸术(IMFA)的治疗效果。方法:将42例PCOS合并克罗米芬(CC)抵抗的不孕患者,随机分为A组:19例,穿刺前用CC或来曲唑(LE)联合少量hMG促排卵;B组:23例,穿刺前用少量hMG促排卵。在阴道B超引导下进行未成熟卵泡抽吸术(IMFA),观察穿刺前及穿刺后第2周期患者的卵巢基础窦卵泡数(AFC)、抗苗勒氏管激素(AMH)、血中游离睾酮指数(FAI)、黄体生成素与卵泡刺激素的比值(LH/FSH),以及术后并发症、3个月促排卵情况和妊娠率。结果:42例患者治疗时均没有发生卵巢过度刺激综合征(OHSS)。与治疗前比较,穿刺术后A、B组AFC显著减少,AMH、FAI和LH/FSH显著降低(P<0.01)。A、B组间比较,FAI、LH/FSH、排卵率和妊娠率无统计学差异(P>0.05)。A、B组共21例妊娠,妊娠率为50%。42例患者均没有发生出血、感染、OHSS。结论:IMFA治疗克罗米芬抵抗的PCOS不孕患者有较好的疗效,本方法安全、有效。     

人工授精周期诱导排卵药物及方案的研究进展

诱导排卵联合宫腔内人工授精是广泛应用的一项辅助生育技术。诱导排卵目的是形成单一卵泡的发育成熟,尽可能地减少发生多胎妊娠和卵巢过度刺激综合征的风险。抗雌激素类和芳香化酶抑制剂因口服方便而广泛应用,单独使用妊娠率较低。促性腺激素类药物可以获得较高的临床妊娠率,采用小剂量递增的温和方案不但能够保证较高的单卵泡发育还能够明显的减少并发症的发生。关于促性腺激素促排卵治疗中卵巢反应预测因子还有待于进一步研究。     

促黄体生成激素释放激素(LHRH)显效剂和外源性促性腺激素的联合应用成功治疗月经过少的不育妇女

在促黄体生成激素(LH)水平增高(多囊卵巢综合征)的月经过少不育妇女中,传统治疗以舒经酚刺激卵泡生长,部分病人即使孕激素水平已够仍不妊娠.应用外源性促性腺激素治疗这类病人很难诱发排卵,而且比性腺功能减退的病人妊娠率都低同时常发生卵巢肿大     

腹腔镜下采用绝缘针烧灼治疗多囊卵巢的评估

对患多囊卵巢综合征 (Polycystic ovary syndrome,PCOS)无排卵不孕的妇女 ,第一线治疗是克罗米芬 (柠檬酸盐 )。该药促排卵率 >80 %。然而 ,15 %～ 2 0 %妇女增加克罗米芬量仍然无排卵。此外 ,排卵率与妊娠率 40 %～ 5 0 %不相符合 ,流产率高 (30 %～40 % )。克罗米芬耐药的妇女可采用促性腺激素或脉冲式 L H释放激素 (L H- RH)治疗。但是 ,二者成功率均不高。替代药物治疗的方法是手术治疗。目前 ,最普遍的手术治疗是腹腔镜下卵巢打洞。1990年 6月至 1998年 12月 ,112例 PCOS无排卵不孕妇女 ,采用规范腹腔镜卵巢电凝打洞 ,所有妇女均…     

促性腺激素释放激素激动剂在多囊卵巢综合征促排卵高危周期中的应用

目的探讨促性腺激素释放激素激动剂（ＧｎＲＨａ）代替ｈＣＧ在多囊卵巢综合征（ＰＣＯＳ）中诱发排卵治疗的效果及并发症。方法对采用绝经期促性腺激素或卵泡刺激素促排卵治疗的１４例ＰＣＯＳ患者（１８个周期）,于卵泡≥１８ｍｍ时给予ＧｎＲＨａ,观测血清雌二醇（Ｅ２）水平、排卵率、妊娠率、卵巢过度刺激综合征（ＯＨＳＳ）和多胎妊娠发生情况。结果１４例１８个治疗周期给予ＧｎＲＨａ日血清Ｅ２为（８３７９±２９５８）ｐｍｏｌ／Ｌ,周期排卵率和妊娠率分别为８３３％和２２２％。中度ＯＨＳＳ和多胎妊娠各１例。结论在ＰＣＯＳ不孕患者中以ＧｎＲＨａ代替ｈＣＧ具有相似的排卵率和妊娠率,但能明显降低ＯＨＳＳ发生率,减少多胎妊娠。     

超声下未成熟卵泡抽吸术治疗多囊卵巢综合征不孕的临床研究

目的　探讨超声下未成熟卵泡抽吸术(IMFA)对多囊卵巢综合征(PCOS)不孕患者卵巢窦卵泡计数及其内分泌功能的影响;观察IMFA后,应用人绝经期促性腺激素(hMG)促排卵治疗的效果、妊娠及并发症情况。方法　将71例PCOS不孕患者随机分为两组。组Ⅰ: 37例,穿刺前用少量hMG促排卵; 组Ⅱ: 34例,不用任何促排卵药物。在阴道超声引导下进行IMFA,检查穿刺后第2个周期患者的内分泌功能和卵巢基础窦卵泡计数,可连续2~3个周期进行穿刺。随后2组均用hMG常规促排卵治疗,随访其排卵及妊娠情况。结果　组Ⅰ进行了88个周期的穿刺治疗,经过2~3次穿刺后,睾酮水平、黄体生成素(LH )与卵泡刺激素(FSH)的比值均明显降低,与治疗前比较,差异有统计学意义(P<0. 01), 33例(89%, 33 /38)患者基础窦卵泡计数降至10个/卵巢以下。组Ⅱ进行了87个周期治疗,所有患者睾酮水平均显著降低,与治疗前比较,差异有统计学意义(P<0 01 ); 30例LH/FSH<2, 28例(82%, 28 /34)患者基础窦卵泡计数降到10个/卵巢以下。在IMFA之后, 诱发排卵时hMG用量组Ⅰ为(21±6)支,组Ⅱ(23±10)支,两组比较,差异无统计学意义(P>0 .05),在注射人绒毛膜促性腺激素(hCG)后均出现排卵, 组Ⅱ有2例发生轻度卵巢过度刺激综合征(OHSS)。连续促排卵治疗1 ~3个月后, 共36例(51% )     

GnRH-a治疗难治性排卵障碍不孕患者的初步观察

目的探讨常规诱导排卵失败后应用促性腺激素释放激素激动剂(GnRH-a)诱导排卵的临床效果.方法对常规促排卵治疗(氯米芬和HMG)失败的13例排卵障碍不孕患者,其中多囊卵巢综合症(PCOS)5例,小卵泡排卵8例.采用GnRH-a+HMG治疗,并于周期第8天开始B超监测卵泡发育并测定尿LH,当卵泡平均径线达18 mm或尿LH(+)时,给HCG诱发排卵.结果13例患者采用GnRH-a+HMG治疗19个周期,均有优势卵泡发育,其中16个周期(84.2%)卵泡平均径线达18 mm时尿LH仍为(-),给HCG诱发排卵;3个周期提前出现LH峰,取消使用HCG.36.8%的周期为单卵泡发育,75.0%为＜3个优势卵泡,8.3%为4～10个,18.8%为＞10个.妊娠率58.3%,周期妊娠率41.2%,其中单胎4例,双胎2例,4胎1例;自然流产的发生率为14.3%.结论GnRH-a可增强PCOS患者对HMG的反应性,防止内源性LH峰早现,并有良好的妊娠率及妊娠结局,可望作为治疗PCOS及小卵泡排卵患者的二线药物;低剂量HMG可使75%的治疗周期中卵泡发育数＜3个.     

Octreotide is not useful for clomiphene citrate resistance in patients with polycystic ovary syndrome but may reduce the likelihood of ovarian hyperstimulation syndrome

OBJECTIVE: To determine whether octreotide is effective for ovulation induction in patients with polycystic ovary syndrome (PCOS) and clomiphene citrate resistance or for reduction of the risk of ovarian hyperstimulation syndrome (OHSS) with gonadotropin therapy. DESIGN: Prospective, double-blind, placebo-controlled, crossover trial. SETTING: Private infertility practice. PATIENT(S): Twelve patients with PCOS undergoing therapy for infertility. INTERVENTION(S): The patients were assigned randomly to receive either octreotide or placebo. Those with clomiphene citrate-resistant PCOS received clomiphene citrate, 150 mg. Patients at risk for the development of OHSS received urinary FSH for ovulation induction. MAIN OUTCOME MEASURE(S): Ovulation, pregnancy, the development of OHSS, and levels of fasting insulin, insulin-like growth factor 1, insulin-like growth factor binding proteins 1 and 3, testosterone, androstenedione, DHEAS, E2, LH, and FSH. RESULT(S): Octreotide significantly reduced levels of fasting insulin, insulin-like growth factor 1, and LH in both clomiphene citrate- and urinary FSH-stimulated cycles. Levels of insulin-like growth factor binding protein 3 were increased. Two of six clomiphene citrate-stimulated cycles reached ovulation with the use of either octreotide or placebo. In urinary FSH-stimulated cycles, patients who received octreotide had significantly lower E2 levels at the time of hCG administration and fewer mature follicles. No cases of OHSS occurred in either group. One pregnancy occurred in each group. CONCLUSION(S): Octreotide was no more effective than placebo for clomiphene citrate resistance in patients with PCOS, but it did reduce E2 levels and follicle numbers when combined with urinary FSH. Thus, octreotide may reduce the incidence of OHSS in patients with PCOS.     

Surgical or medical treatment of polycystic ovary syndrome: a cost-benefit analysis.

With the availability of laparoscopic ovarian cautery, there has been a resurgence in interest in the surgical treatment of clomiphene citrate-resistant polycystic ovary syndrome (PCOS). Comparison of ovulation and pregnancy rates has found no difference in success rates between ovarian cautery and gonadotropin ovulation induction for such women. We have therefore compared the cost of laparoscopic ovarian cautery with that of a typical cycle of gonadotropin ovulation induction, and also found that there is little difference. Because of the potential advantages of ovarian cautery, we recommend this surgery as the next line of treatment if clomiphene citrate fails to induce ovulation in PCOS patients, before gonadotropins are introduced.     

Fertility after ovarian drilling by transvaginal fertiloscopy for treatment of polycystic ovary syndrome

STUDY OBJECTIVE: To evaluate fertiloscopy ovarian drilling with bipolar energy in women with clomiphene citrate-resistant polycystic ovary syndrome (PCOS). DESIGN: Prospective study (Canadian Task Force classification II). SETTING: University teaching hospital and private clinic. PATIENTS: Eighty women with clomiphene citrate-resistant PCOS. INTERVENTION: Operative transvaginal fertiloscopy with a coaxial bipolar electrode. MEASUREMENTS AND MAIN RESULTS: During a mean follow-up of 18.1 months (+/- 6.4), 73 women (91%) recovered regular and ovulatory cycles. The cumulative pregnancy rate was 60% (44/73) for spontaneous and stimulated cycles, with 39.7% (29/73) imputed to drilling alone. The mean time to conceive was 3.9 months (range 1-11.8). There were eight miscarriages (18%), and no ectopic pregnancies or multiple pregnancy. No complications occurred. CONCLUSION: Ovarian drilling by transvaginal fertiloscopy with bipolar electrosurgery appears to be an effective minimally invasive procedure in patients with PCOS resistant to clomiphene citrate.     

卵泡期地塞米松应用对克罗米芬抵抗的多囊卵巢综合征促排卵作用研究

目的:探讨克罗米芬(CC)联合地塞米松(DEX)对CC抵抗的多囊卵巢综合征(PCOS)患者的促排卵效果。方法:将50名CC抵抗患者随机分为治疗组(A组)和对照组(B组)。A组患者在月经第3￣7日口服CC100mg/d,同时在月经周期的第3￣12日口服DEX1.0mg/d;B组CC的应用同A组,同时在月经周期的第3￣12日口服叶酸片0.5mg/d。月经第8日开始监测卵泡发育情况。当有1个卵泡直径≥18mm或2个卵泡直径≥17mm时,肌注hCG10000IU,36h后性生活。观察2组注射hCG日成熟卵泡数和子宫内膜厚度、促排卵天数、月经周期第22日孕酮水平、排卵率和妊娠率。结果:A组注射hCG日的成熟卵泡数、子宫内膜厚度、月经第22日血清中孕酮水平以及排卵率和妊娠率与B组相比差异均有显著性(P<0.05￣P<0.01);促排卵天数组间无统计学差异(P>0.05)。结论:对CC抵抗的PCOS患者,DEX可以促进排卵,改善CC对子宫内膜的抗雌激素效应,增加子宫内膜厚度,提高排卵率和妊娠率。     

Operative transvaginal hydrolaparoscopy for treatment of polycystic ovary syndrome: a new minimally invasive surgery

OBJECTIVE: To evaluate a new minimally invasive surgery for treatment of the polycystic ovary syndrome (PCOS) in clomiphene-resistant infertile women. DESIGN: Prospective study. SETTING: University teaching hospital. PATIENT(S): Thirteen clomiphene citrate-resistant anovulatory women with PCOS. INTERVENTION(S): Operative transvaginal hydrolaparoscopy (THL) using a coaxial bipolar electrode. MAIN OUTCOME MEASURE(S): Feasability, ovulation rate, and pregnancy rate. RESULT(S): Ovarian drilling was performed by THL in all patients; no surgical complications occurred. Mean (+/-SD) duration of follow-up time was 6.3 +/- 3.3 months. Six patients recovered to have regular ovulatory cycles. Six pregnancies occurred; three were spontaneous, two occurred after stimulation and intrauterine insemination, and one occurred after IVF. The cumulative pregnancy rate was 33% at 3 months after THL and 71% at 6 months after THL. No miscarriages occurred. CONCLUSION(S): Transvaginal hydrolaparoscopy with ovarian drilling using bipolar electrosurgery appears to be an alternative minimally invasive in patients with PCOS who are resistant to clomiphene therapy.     

Use of dexamethasone and clomiphene citrate in the treatment of clomiphene citrate-resistant patients with polycystic ovary syndrome and normal dehydroepiandrosterone sulfate levels: a prospective,double-blind,placebo-controlled trial

OBJECTIVE: To evaluate the effects of short-course administration of dexamethasone (DEX) combined with clomiphene citrate (CC) in CC-resistant patients with polycystic ovary syndrome (PCOS) and normal DHEAS levels. DESIGN: Prospective, double-blind, placebo-controlled, randomized study. SETTING: Referral university hospitals. PATIENT(S): Two hundred thirty women with PCOS and normal DHEAS who failed to ovulate after a routine protocol of CC. INTERVENTION(S): The treatment group received 200 mg of CC from day 5 to day 9 and 2 mg of DEX from day 5 to day 14 of the menstrual cycle. The control group received the same protocol of CC combined with placebo. MAIN OUTCOME MEASURE(S): Follicular development, hormonal status, ovulation rate, pregnancy rate. RESULT(S): Mean follicular diameters were 18.4124 +/- 2.4314 mm and 13.8585 +/- 2.0722 mm for the treatment and control groups, respectively. Eighty-eight percent of the treatment group and 20% of the control group had evidence of ovulation. The difference in the cumulative pregnancy rate in the treatment and control groups was statistically significant. CONCLUSION(S): Hormonal levels, follicular development, and cumulative pregnancy rates improved with the addition of DEX to CC in CC-resistant patients with PCOS and normal DHEAS. This regimen is recommended before any gonadotropin therapy or surgical intervention.     

Avoidance of multiple pregnancies after ovulation induction by supernumerary preovulatory follicular reduction

OBJECTIVE: To evaluate the effect of supernumerary preovulatory follicular reduction as an approach to avoid multiple pregnancies in ovulation induction or superovulation cycles. DESIGN: Retrospective study. SETTING: Tertiary referral center. PATIENT(S): In 26 cycles, 24 patients underwent ovulation induction or superovulation with either clomiphene citrate or hMG. INTERVENTION(S): Selective follicle aspiration was performed before hCG administration. MAIN OUTCOME MEASURE(S): Clinical pregnancy rate and numbers of multiple pregnancies. RESULT(S): A mean number of 4.5 follicles with a diameter > or =15 mm and a mean number of 4.5 follicles with a diameter < or =14 mm were observed before hCG administration. A mean number of 2.3 follicles with a diameter > or =15 mm and a mean number of 1.8 follicles with a diameter < or =14 mm were aspirated before the hCG administration. Seven singleton pregnancies (26.9% per cycle) ensued from the treatment. CONCLUSION(S): Aspiration of supernumerary follicles after ovulation induction or superovulation seems to be a valid approach to avoid multiple pregnancies without affecting pregnancy rate.     

多囊卵巢综合征患者超排卵过程中行卵泡抽吸的效果观察

目的 观察多囊卵巢综合征(PCOS)患者于行体外受精-胚胎移植(IVF-ET)的超排卵过程中抽吸卵泡的结局。方法 对13例首次行IVF-ET(对照周期)失败、发生卵巢过度刺激征(OHSS)的PCOS不孕患者,于再次行IVF—ET(卵泡抽吸周期)的超排卵过程中,在B超指引下经阴道对苴径9～10 mm的卵泡进行穿刺抽吸,保留直径9～10 mm卵泡≤10个。卵泡抽吸后继续进行超排卵方案。比较两个周期患者血清性激素水平变化及卵子发育等情况。结果 卵泡抽吸周期hCG注射日平均直径≥12 mm的卵泡数为(16±4)个,较对照周期(29±8)个明显减少,两个周期比较,差异有极显著性(P<0.001);卵泡抽吸周期平均血清雌二醇水平为(9899±1430)pmol/L,较对照周期(15 545±1767)pmoL/L明显降低,两个周期比较,差异有极显著性(P<0.001)。卵泡抽吸周期中,无患者发生中、重度OHSS;对照周期中,9例(9/13,69％)患者发生OHSS。卵子回收率、成熟率、受精率、卵裂率及胚胎种植率均显著高于对照周期。结论 于行IVF—ET的超排卵过程中,抽吸直径为9-10 mm的卵泡,能有效减少PCOS不孕患者hCG注射日的优势卵泡数目,降低血清雌二醇水平,减少中、重度OHSS的发生。