来曲唑与枸橼氯米芬对多囊卵巢综征患者诱导排卵的效果分析

目的:比较来曲唑(LE)和枸橼氯米芬(CC)对多囊卵巢综合征(PCOS)患者诱导排卵的效果.方法:经达英-35和二甲双胍治疗后,内分泌正常的PCOS患者72例拟行诱导排卵治疗.随机分为LE组36例和CC组36例,分别于月经周期的第4天开始服用LE与CC,阴道超声监测卵泡发育情况.在卵泡直径≥18 mm时,注射人绒毛膜促性腺激素(HCG)诱导排卵,同时在HCG日抽血测定黄体生成素(LH)、雌二醇(E2)和睾酮(T),并跟踪观察比较两组子宫内膜厚度、优势卵泡数、HMG用量、排卵率、未破裂卵泡黄素化(LUF)发生率和临床妊娠率等.结果:LE组的周期排卵率、妊娠率与CC组相比差异无统计学意义；LE组HCG日E2水平低于CC组(P＜0.05),但子宫内膜厚度大于CC组(P＜0.05),卵巢过度刺激综合征(OHSS)发生率明显低于CC组(P＜0.01),LE组单卵泡排卵率优于CC组.结论:在PCOS诱导排卵治疗中,LE促排卵单卵泡排卵率高,子宫内膜容受性好,可降低多胎妊娠和OHSS的发生率,更适用于PCOS患者促排卵治疗,有望成为PCOS新一代一线诱导排卵药物.

Ovulation induction effects of letrozole and clomiphene citrate in poly-cystic ovary syndrome

AIM： To observe the induced ovulation outcomes using either letrozole（LE） or clomiphene citrate（CC） in women with polycystic ovary syndrome（PCOS）. METHODS： After medication of ethinylestradiol/cyproterone acetate tablets and metformin hydrochloride enteric-coated tablets, 72 PCOS women with normal function of endocrine scheduled ovulation induction were randomly allocated to LE group and CC group（n=36 for each）. The drug was administered orally at the 4th day of the menstrual cycle, and transvaginal ultrasound was performed to monitor the follicle development. By the follicular diameter≥18 mm, human chorionic gonadotropin（HCG） was injected to induce the ovulation, and the blood was simultaneously taken at the same day to determine the levels of luteinizing hormone（LH）, estradiol（E2） and testosterone（T）. The two groups were examined and compared regarding the thickness of endometrium, number of dominant follicle, amount of HMG used, ovulation rate, incidence of LUF and clinical pregnancy rate. RESULTS： The periodic ovulation rate and pregnancy rate had no significance between LE group and CC group. E2 level detected at the day of HCG administration was lower in LE group than the CC group（P〈0.05）, yet thicker endometrium was seen in LE group（P〈0.05）. Additionally, LE group had a lower incidence of ovarian hyperstimulation syndrome （OHSS）（ P〈0.05）, and was superior to CC group concerning single follicle ovulation rate. CONCLUSION： Administration of LE for ovulation induction in women with PCOS may produce higher rate of single follicle ovulation and better endometrial receptivity, but reduce the multiple pregnancy and incidence of OHSS, suggesting that it is favorable to ovulation induction therapy and a promising drug in PCOS patients.