卵泡期经阴道小卵泡穿刺抽吸术治疗多囊卵巢综合征排卵障碍

目的 探讨对克罗米芬治疗无反应的多囊卵巢综合征患者在卵泡期经阴道小卵泡穿刺抽吸术后,使用促性腺激素诱发排卵时卵泡的发育及其结局。方法 选择17例对克罗米芬治疗无反应,或对促性腺激素治疗发生卵巢过度刺激或无反应,但输卵管通畅、男方精液正常的多囊卵巢综合征不孕患者,在月经(人工周期)第5天给予促性腺激素治疗,给药5d后,在B超指引下经阴道行小卵泡穿刺抽吸术,双侧卵巢仅留1—2个较大卵泡,术后继续给予促性腺激素,观察卵泡发育、排卵和妊娠情况及血中性激素水平变化。结果 17例中除2例(11．8％)对该治疗方法无反应外,15例出现优势卵泡发育和排卵,其中单卵泡发育9例(52．9％),双卵泡发育4例(23.5％),3卵泡发育2例(11．8％),发育的优势卵泡全部排卵。总共有7例妊娠,全部为单胎妊娠,单周期治疗妊娠率41．2％(7／17)。结论 卵泡期经阴道小卵泡穿刺抽吸术能使对克罗米芬治疗无反应的多囊卵巢综合征不孕患者,使用促性腺激素治疗获得良好的单卵泡发育和单胎妊娠率。

Transvaginal follicular aspiration in follicle phase in the management of anovulation associated with polycystic ovary syndrome

Objective To investigate the follicle development and pregnancy in clomiphene citrate-resistant patients with polycystic ovary syndrome (PCOS) after transvaginal follicular aspiration and gonadotropin administration. Methods Seventeen clomiphene citrate-resistant patients with PCOS failed to gonadotropin treatment associated with ovarian hyperstimulation syndrone(OHSS). They are anovulatory infertility with normal tubal and husbands'sperm condition. In this treatment regimen,all patients was administered with gonadotropin from day 5 of menstrual cycle(or withdrawal bleeding) and were asked to undergo ultrasound-guided transvaginal follicular aspirations for 5 days later. Only one or two follicles for every ovary were remained and gonadotropin administration was continued. A follicle development,ovulation rate,pregnancy rate and sex hormone were monitored. Results Fifteen of the 17 patients experienced dominant follicles development and ovulation. 9 of them with one(52.9%) ,4 with two(23.5%) and 2 with three(11.8%) dominant follicles ovulated and pregnancy occurred in 7 patiends(41.2%). All of pregnancy are singleton. Conclusion A single follicle development and singleton pregnancy can be realized in clomiphene citrate-resistant PCOS patients by combined ultrasound-guided transvaginal follicular asperation with gonadotropin administration.