未生育妇女卵巢早衰13例临床分析

目的:通过对未生育妇女卵巢早衰患者行激素周期治疗和促排卵治疗,评价其疗效,探讨可能有效的促排卵方案。方法:对13例患者行雌孕激素周期治疗3～6个周期,观察治疗前后患者临床症状、血清激素水平及盆腔超声相子宫的变化,并采用3种方案促排卵治疗。结果:13例患者经雌孕激素治疗3～6个周期后,血清卵泡刺激素(FSH)、黄体生成素(LH)水平明显下降(P<0.01),血清雌二醇(E2)与服药前相比差异无显著性(P>0.05),与治疗前比较B超子宫横切面的横径、前后径有增厚(P<0.05),但子宫纵切面的长径与治疗前相比差异无显著性(P>0.05),子宫内膜显著增厚(P<0.01)。以人绝经期促性腺激素(HMG)/人绒毛膜促性腺激素(HCG)方案和促性腺激素释放激素激动剂(GnRHa)/HMG/HCG方案促排卵治疗有成熟卵泡发育并各有1例妊娠。结论:卵巢早衰患者应尽可能查明病因,针对病因治疗,并尽早行激素周期治疗,有利于促排卵治疗成功,HMG/HCG和GnRHa/HMG/HCG这两种促排卵方案均有可行性。

The Clinical Analysis of 13 Nulliparous Women with Premature Ovarian Failure

Objective:To evaluate the effect of hormone therapy (HT) and sequently inducing ovulation treatment in nulliparous women with the premature ovarian failure (POF),and to explore the possible effective ovulation inducing scheme.Methods:13 patients with POF were treated by HT for 3 to 6 cycles.The clinical symptoms,serum sex-hormone levels,and the transvaginal ultrasonography of pelvis were observed before and after the treatment.Meantime,three schemes of ovarian inducing protocols (CC alone,HMG/HCG,and GnRH-a/HMG/HCG) were applied in these patients.Results:After 3 to 6 cycles of HT,the serum FSH,LH level of 13 patients with recovery of mense dropped significantly (P<0.01),while E2 raised slightly (P>0.05).By ultrasonography,there's no significant difference of long-diameter of uterine longitudinal section after HT,when compared to baseline (P>0.05);however,the transverse diameter and anteroposterior of uterine transverse section (P<0.05),and the thickness of endometrium (P<0.01) increased significantly after HT than baseline.In three schemes for ovulatory induce treatment,the latter two have succeed in inducing follicular development and mature in three cases,and two pregnancies.Conclusions:The cause of POF should be made certain,hormone therapy for pretreatment before inducing ovulation can be used.The schemes of HMG/HCG and GnRH-a/HMG/HCG have the feasibility for inducing ovulation in POF women.