尿促性素治疗难治性高雄激素血症所致不孕疗效观察

目的探讨难治性高雄激素血症不孕患者经尿促性素（HMG）促排卵后的临床妊娠情况。方法经临床诊断为高雄激素血症患者156例，经3—6个月经周期药物治疗后，睾酮（T）值仍然高于正常的高雄激素血症患者或多囊卵巢综合征（PCOS）伴高雄激素血症患者33例：治疗组18例于月经周期的第4～8天给予HMG75U／d促排卵，对照组15例自然周期监测排卵。均于月经第9天开始经阴道B超监测卵泡大小和子宫内膜厚度，并根据卵泡大小决定治疗组是否继续应用HMG以及是否加量，至优势卵泡最大卵泡平均直径（MFD）≥18mm时，肌注人绒毛膜促性腺激素（HCG）10000U。追踪观察2组临床结果。结果治疗组平均子宫内膜厚度与对照组无明显差异（P〉0．05），但治疗组周期排卵率85．7％（24／28）、临床妊娠率55．6％（10／18）均高于对照组的周期排卵率62．5％（15／24）和临床妊娠率13．3％（2／15），差异显著（P〈0．05）。2组中各有1例自然流产，治疗组1例双胎妊娠并发生卵巢过度刺激。结论高雄激素血症患者经3—6个周期的药物治疗后，尽管T仍高于正常，但可以进行促排卵治疗，HMG促排卯可获得较高的妊娠率。

Clinical study of the effect of HMG on the infertility due to intractable hyperandrogenaemia

Objective To investigate the clinical effect of induced ovulation by HMG on pregnancy in women patients with infertility due to intractable hyperandrogenaemia. Methods 156 women patients with clinically diagnosed hyperandrogenaemia underwent medication for 3 to 6 menstrual periods, of whom 33 patients with hyperandrogenaemia or polycystic ovary syndrome （PCOS） plus hyperandrogenaemia still had higher testosterone levels than normal. They were divided into the treatment group （18 patients）, who were given intramuscular injection of HMG 75 U/d for 5 days from the 4th to the 8th day of menstrual period, while the other 15 women were designated as the control group and monitored for ovulation in natural cycles. The follicle diameter and endometrial thickness were monitored by transvaginal type - B ultrasonography as of the 9th day. It was dependent on the follicle sizes whether the application and the amount of HMG should be continued or increased. When the max follicle MFD ≥18 mm, the women were given intramuscular injection of human chorionic gonadotropin （HCG） 10 000 U. Results No significant difference was found between the two groups in average endometrial thickness on HCG days （P 〉 0.05）. The treatment group had a higher cycle ovulation rate of 85.7% （24/28） and clinical pregnancy rate 55.6% （10/18） compared with the respective rates of 62.5% （15/24） and 13.3% （2/15） in the control group （P 〈 0.05 ）. There was one case of spontaneous abortion in each of the two groups. 1 case had twin pregnancy with ovarian hyperstimulation syndrome （OHSS） in the treatment group. Conclusion Subsequent to the medication for 3 - 6 menstrual periods in patients with hyperandrogenaemia, while the testosterone levels were still higher than normal, the patients could be given the treatment of induced ovulation with HMG for possibly higher pregnancy rate.