Changes of serum follicular stimulating hormone, luteinizing hormone and follicular sizes during electroacupuncture for induction of ovulation

Changes in follicular stimulating hormone (FSH), luteinizing hormone (LH) and follicular sizes were observed in 10 patients with chronic anovulation during electroacupuncture treatment. Seven cases were diagnosed as suffering from polycystic ovary syndrome, 2 from dysfunctional uterine bleeding, and 1 from hypogonadotropic amenorrhea. Among them 8 cases complained of infertility for an average of 2. 7years. Ovulation was confirmed by pregnancy or the combination of biphasic basal body temperature and ultrasonographic signs. During one course of 3 consecutive days of electroacupuncture treatment on acupoints Guanyuan (Ren 4), Zhongji (Ren 3), Zigong (Extra 16) and Sanyingjiao (Sp 6), ovulation resulted in 5 patients (ovulating group) and 3 of the 4 infertile women became pregnant. Five cases failed to ovulate (non-ovulating group), 3 of them reached a biphasic basal body temperature without ovulatory signs on ultrasonograph. Serum FSH, LH values and FSH pulse frequency increased significantly during-electroacupuncture treatment in the ovulating group (from 2. 10±0.42 pulses/4h to 3. 70±1.64 pulses/4 h), but not in the non-ovulating group. No apparent change was found in LH pulse frequency, or in pulse amplitudes for FSH and LH. In the ovulating group, diameters of ovarian follicules markedly increased, but their growth was limited in the non-ovulation group. The results suggest ovulation may be induced by electroacupuncture via a regulation on the hypothalamic-pituitary function, leading to normal secretion of FSH and LH.     

电针治疗排卵障碍性不孕症40例临床研究

目的本研究拟对电针治疗排卵障碍性不孕症患者进行临床研究,并初步探讨其作用机制。方法选取40例排卵障碍性不孕患者,比较治疗前后临床疗效、排卵率、治疗后一年的妊娠率以及血清促性腺激素（LH、FSH）、性激素（E2、P）水平的变化,通过B超监测比较患者主卵泡发育及子宫内膜生长的情况。结果排卵障碍性不孕症患者经电针干预后治疗的总有效率为77.5%,排卵率为45%,一年后妊娠率为22.5%,血清LH、FSH、E2、P水平治疗前后差异有统计学意义（P〈0.05）,子宫内膜和卵泡发育生长的情况治疗前后差异均有统计学意义（P〈0.05）。结论补肾立法的电针方法对排卵障碍性不孕患者血清促性腺激素和性激素具有良好的调节作用,从而促进卵泡的发育,达到促排卵的目的 ,对排卵障碍有较好的疗效。     

育龄期功能失调性子宫出血的T淋巴细胞亚群变化

为探讨功能失调性子宫出血的病理基础、内分泌改变与免疫功能变化之间的关系，用放射免疫测定了66例成人功血患者（分有排卵组30例和无排卵组36例）的血浆FSH、LH、PRL、E2、T，同时用间接免疫荧光法检测其外周血淋巴细胞的CD3、CD4、CD8、CD20。结果与正常对照组比较显示：有排卵组FSH和E2水平较低（P＜0．05），PRL水平较高（P＜0．01），CD4和CD4／CD8降低（P＜0．01），CD8升高（P＜0．01）；无排卵组LH、PRL、E2、T均较对照组高（P＜0．01），CD3、CD4、及CD4／CD8均较低，CD20则呈现升高（P＜0．05）。提示：成人功血的病理过程与免疫功能变化的关系密切。     

自拟养精种子汤用于腹腔镜术后难治性PCOS不孕患者的疗效观察

目的观察腹腔镜卵巢打孔术联合自拟养精种子汤以及来曲唑促排卯两种方案治疗难治性多囊卵巢综合征（PCOS）不孕患者的临床疗效。方法将268例PCOS不孕患者随机分为治疗组和对照组,治疗组腹腔镜术后应用自拟养精种子汤口服。对照组腹腔镜术后辅助来曲唑促排卵治疗。观测两组患者治疗前后睾酮（T）、促卵泡生成素（FSH）、促黄体生成素（LH）、雌激素（E2）及LH／FSH变化,同时观察排卵率、妊娠率、不良反应情况。结果两组患者治疗1个疗程后,LH、LH／FSH、T水平均明显下降,与本组治疗前比较差异有统计学意义（P〈0．01）;术后6个月治疗组性激素水平仍保持治疗1个疗程后水平,而对照组LH、LH／FSH、T水平上升,基本恢复治疗前水平。治疗组的排卵及妊娠率均明显优于对照组（P〈0．05）,两组患者流产率比较无明显差异,各组患者均未出现多胎及卵巢过度刺激综合征（OHSS）。结论腹腔镜术后联合养精种子汤口服能有效调节难治性PCOS患者的性激素水平,结合了中西医治疗的优势,值得临床广泛推广应用。     

克罗米芬联合桂枝茯苓胶囊治疗PCOS不育的临床研究

目的观察桂枝茯苓胶囊联合克罗米芬对多囊卵巢综合症不育患者的代谢功能、内分泌和妊娠的影响。方法患者随机分克罗米芬治疗组及桂枝茯苓胶囊＋克罗米芬联合治疗组。观察药物治疗对患者FSH、LH、T、G、INS、TC、TG、HDL—C、LDL—C及BMI指数的影响。结果桂枝茯苓胶囊＋克罗米芬联合治疗显著缓解患者机体胰岛素抵抗（P〈0．01），并改善机体脂代谢，增加HDL—C水平（P〈0．05）；显著降低血清LH和T浓度，获得比单用克罗米芬更好的排卵率和妊娠率。结论桂枝茯苓胶囊与克罗米芬联用能改善机体的糖代谢和脂代谢水平，调节性激素分泌，其促排卵和妊娠效果优于单用克罗米芬。     

子宫内膜异位症与卵巢功能

目的 :探讨子宫内膜异位症 (Em)的内分泌改变与卵巢功能的关系。方法 :用放射免疫 (RIA)法对 68例子宫内膜异位症患者进行血清激素测定及基础体温 (BBT)测量 ,对 3 0例患者行子宫内膜活检及B超检查 ,对 8例患者行腹水和卵泡液的激素测定。结果 :68例患者中血清泌乳素 (PRL)升高者 2 4例、正常者 44例 ;卵泡刺激素(FSH)正常者 3 7例、低于正常者 16例、高于正常者 15例 ;黄体生成素 (LH)正常者 3 8例、低于正常者 16例、高于正常者 14例 ;雌激素 (E2 )正常者 49例、低于正常者 16例、高于正常者 3例 ;孕激素 (P)正常者 3 6例、低于正常者 3 2例。 3 0例行子宫内膜活检 ,腺体分泌不良者 8例、属增生期内膜者 15例。对 8例患者分别取腹水及卵泡液测定FSH、LH、E2 、P值。在黄体期卵泡液的E2 及P值分别高于腹水的 2 0～ 2 5倍 ,且腹水的E2 及P值均低于血清值。结论 :子宫内膜异位症患者内分泌的变化影响卵巢功能 ,导致排卵障碍与不排卵 ,从而影响月经或导致不孕     

基础卵泡刺激素/黄体生成素比值与控制性超排卵中卵巢反应性的关系

目的探索血基础卵泡刺激素(FSH)/黄体生成素(LH)比值及启动日FSH/LH比值在预测控制性超排卵(COH)中卵巢反应性的价值。方法对891个COH周期分为超排卵治疗不反应组（70个周期）、低反应组(56个周期)及正常反应组(765个周期),比较了3组的基础FSH、LH和雌激素(E2)水平,以及使用促性腺激素释放激素激动剂(GnRHa)后FSH、LH和E2水平的变化,促性腺激素（Gn）的用量等。激素的测定采用全自动酶联免疫分析法。结果不反应组的基础FSH值为9.7IU/L±7.8IU/L,分别与低反应组（7.8IU/L±5.4IU/L）及正常反应组(6.4IU/L±2.0IU/L)比较均差异有显著意义（P<0.01）。不反应组的基础FSH/LH比值为2.9,分别与低反应组（2.0）及正常反应组(1.6)比较差异有显著意义（P<0.05）。使用GnRHa1周后(启动日月经来潮1～3d),不反应组FSH/LH比值为5.3,低反应组为3.9,两者与基础水平比较均明显增高（P均<0.01）,而正常反应组(2.6)增高不明显。基础E2水平在低反应组增高,与正常反应组比较P=0.09。结论当基础FSH<15IU/L时,可以通过使用GnRHa后,FSH/LH比值的显著增加及E2水平来进一步判断卵巢的反应性,指导临床用药。     

Female infertility: role of vaginal hormonal cytology, endometrial biopsy and endocrinological evaluation

Female infertility can be categorised into those who fail to ovulate (anovulatory infertility) because of some defect at hypothalamic-pituitary-ovarian axis and those who are ovulatory (ovulatory infertility), but are infertile because of some lesion present in genital tract. The role of vaginal hormonal cytology, endometrial biopsy and endocrinological evaluation in the detection of ovulation and various ovulatory dysfunction was studied in 42 infertile female patients. On the basis of cytological findings, of the 42 patients, 14 were found to be ovulatory, 26 anovulatory (which include 5 cases of atrophic changes) and 2 inconsistent due to inflammatory changes. Endometrial biopsy showed evidence of ovulation in 15, anovulation in 27 cases. Hormonal evaluation indicated some sort of endocrinological disorders in 15 patients, which may underlie anovulatory infertility in these patients, while results were within normal range in the rest 27 patients. Results of vaginal cytology and endometrial biopsy showed correlation in respect to ovulation in 93.33% of the cases.     

促排卵验方联合枸橼酸氯米芬片辨治肾虚血瘀型排卵障碍性不孕症患者的临床研究

目的观察促排卵验方联合枸橼酸氯米芬片辨治肾虚血瘀型排卵障碍性不孕症患者的临床效果。方法选择于我院就诊的肾虚血瘀型排卵障碍性不孕症患者90例为对象,随机分为对照组和观察组各45例。对照组口服枸橼酸氯米芬片,观察组则加用促排卵验方内服。对比两组治疗的妊娠率;记录基础体温BBT及激素水平变化;于排卵期监测子宫内膜厚度、优势卵泡直径及成熟卵泡个数。结果观察组的妊娠率高达68.9%,与对照组37.8%的妊娠率相比显著升高(P0.05);观察组的BBT改善优于对照组,其BBT正常率高达82.2%,显著高于对照组的46.7%(P0.05);观察组经治疗后血清雌二醇(E_2)、黄体生成激素(LH)、促卵泡激素(FSH)水平显著高于对照组(P0.05);观察组经治疗后其子宫内膜厚于对照组,优势卵泡直径较对照组明显增大,成熟卵泡个数较对照组明显增多(P0.05)。结论促排卵验方联合枸橼酸氯米芬片治疗肾虚血瘀型排卵障碍性不孕症疗效肯定,其能显著改善BBT,提高激素水平,促进子宫内膜的发育及卵子的成熟、排出,值得临床推广运用。     

吡格列酮联合克罗米芬治疗多囊卵巢综合征44例疗效观察

目的观察吡格列酮联合克罗米芬治疗多囊卵巢综合征（polycystic ovary syndrome,PCOS）的疗效。方法将44例患者随机分为单用克罗米芬组、单用吡格列酮组和联合用药组3组,测量患者体重并计算体重指数（BMI）,测定患者血清卵泡刺激素（FSH）、黄体生成素（LH）、睾酮（T）、空腹血糖（FBG）及胰岛素（FBI）水平,自测基础体温（BBT）及B超监测排卵,并进行治疗前后的比较。结果联合用药组除FSH外,其他指标均获得明显改善。结论吡格列酮联合克罗米芬治疗PCOS较单用其中之一效果显著。     

尿孕酮酶免法对健康妇女无排卵月经周期的研究

目的 实验观察３８名健康妇女连续２～３个月经周期中无排卵所出现的频率。方法 收集每日第１次晨尿,用酶联免疫法分别测定孕酮在尿中的代谢产物３－葡萄糖苷酸孕二醇（ｐｒｅｇｎａｎｅｌｉｏｌ－３－ｇｌｕｃｕｒｏｎｉｄｅ,ＰｄＧ）、卵泡刺激素（ＦＳＨ）以及肌酐（ｃｒｅａｔｉｎｔｉｎｅ,Ｃｒ）。结果 发现无排卵人数所出现的频率为７．９０％,无排卵周期发生的频率为７．６９％。无排卵周期与正常排卵周期相比,ＦＳＨ     

蔡氏调周法治疗肥胖型多囊卵巢综合征的临床研究

目的 观察蔡氏调周法治疗肥胖型多囊卵巢综合征(polycystic ovary syndrome,PCOS)患者的临床疗效。 方法 选取2016年7月—2019年6月上海市第一人民医院及上海中医药大学附属龙华医院的119例肥胖型PCOS患者,采用非随机同期对照的方法分为2组,治疗组(59例)经后期及经间期予多囊方,经前期予多囊方去皂角刺加仙茅、紫石英、鹿角霜,对照组(60例)服用二甲双胍,均治疗3个月。观察治疗前后腰臀比(WHR)、体重指数(BMI),睾酮(T)、促卵泡生成素(FSH)、黄体刺激素(LH)、LH/FSH比值,糖代谢相关指标,中医证候积分,治疗期间基础体温(BBT)及安全性指标等。 结果 治疗后治疗组痊愈22例、显效4例、有效25例,对照组分别为9、8、25例,治疗组疗效明显优于对照组(Z=-2.658,P=0.008)。治疗组治疗后BBT的复常率、妊娠率均优于对照组(均P<0.05),肾虚痰瘀证候积分及LH、LH/FSH比值也较对照组明显降低(均P<0.05)。治疗后2组的BMI、WHR、空腹胰岛素、胰岛素抵抗指数均较治疗前明显降低(均P<0.05),但2组间比较差异无统计学意义(均P>0.05)。 结论 蔡氏调周法能较好地改善肥胖型PCOS患者的性激素水平,有效地调节糖代谢紊乱、降低体重,改善患者肾虚痰瘀证候,起到了促进排卵和恢复规律月经及预防远期并发症的作用,总体临床疗效较好。      

二甲双胍联合达因-35治疗多囊卵巢综合征56例临床观察

目的:观察二甲双胍联合达因-35治疗多囊卵巢综合征(PCOS)的疗效。方法:PCOS患者104例,随机分为治疗组56例,口服达因-35联合二甲双胍治疗;对照组48例,口服二甲双胍治疗;2组在用药3个月后停药,均用来曲唑+人绒毛促性腺激素促排卵治疗,观察比较2组患者促卵泡激素(FSH)、血清睾酮(T)、促黄体激素(LH)、空腹胰岛素(FINS)、空腹血糖(FPG)水平、排卵率和妊娠率。结果:治疗组治疗后LH、T及FPG水平均好于对照组(P0.01),2组间FSH和FINS、黄素化未破裂卵泡综合征、排卵率、妊娠率差异均无统计学意义(P0.05)。结论:达因-35二甲双胍联合能有效改善PCOS患者激素分泌情况,但是对于排卵与妊娠情况无影响。     

达因35和螺内酯治疗高雄激素血症性月经病的疗效比较

目的:探讨达因35和螺内酯对高雄激素血症月经病的临床效果及二者优缺点。方法:选择73例高雄激素血症月经病患者,随机分成A、B两组,A组用达因35治疗,B组用螺内酯治疗,两组均联合克罗米酚治疗。治疗前及治疗后3个月、6个月检测血清性激素:T、A2、FSH、LH。并观察治疗3个月、6个月及停药后6个月、9个月、1年的月经情况、BBT(基础体温)或B超监测卵泡,观察两组副作用。结果:达因35治疗3个月,血清T、A2、LH下降,与治疗前比P<0.05,31例月经恢复正常周期,随访半年21例、1年13例月经周期仍正常。副反应44％。螺内酯组治疗6个月,血清T、A2、LH下降,P相似文献   

腹腔镜手术与克罗米酚治疗多囊卵巢综合征的临床疗效比较

目的 比较腹腔镜手术与口服克罗米酚(CC)治疗多囊卵巢综合征的临床价值及特点.方法 回顾性分析了近年行腹腔镜下卵巢打孔术的28例PCOS患者和口服CC治疗的30例PCOS患者的临床资料,观察其术前、术后激素变化情况以及术后排卵和妊娠情况,并将二者进行对照比较.结果 两组患者治疗前后LH、T和LH/FSH值改变差异均有统计学意义(P＜0.05);术后FSH值及组间各值比较,差异无统计学意义(P＞0.05).恢复正常月经周期率及排卵率两组比较,差异无统计学意义(P＞0.05),但术后妊娠率腹腔镜组(73.08%)显著高于口服CC组(37.93%),差异有统计学意义(P＜0.01).结论 腹腔镜下卵巢打孔术治疗PCOS与口服CC治疗PCOS相比更具优越性,对于口服CC治疗疗效不佳或有迫切生育要求的PCOS患者,可选用腹腔镜手术治疗以提高妊娠率.     

Effect of Rosiglitazone on Endocrine, Metabolism and Ovulatory Performance in Patients with Polycystic Ovary Syndrome and Insulin Resistance

Polycysticovarysyndrome (PCOS) ,character izedbychronicanovulation ,elevatedLHlevels ,andhyperandrogenism ,isthemostcommonendocrinedisorderinwomenofreproductiveage ,affectingap proximately 6 %ofthispopulation[1] .Recentreports[2 ,3] stronglysuggestthatins…     

放线菌素D,环磷酰胺,氨甲喋呤序贯化疗对卵巢功能的影响

目的　探讨放线菌素－Ｄ、环磷酰胺、氨甲喋呤（ＡＣＭ）三联序贯方案治疗滋养细胞肿瘤时对卵巢功能的影响。方法观察了１７例滋养细胞肿瘤化疗前后月经、基础体温、血绒毛膜促性腺激素 亚单位（ ｈＣＧ）、雌二醇（Ｅ_２）、卵泡刺激素（ＦＳＨ）、黄体生成素（ＬＨ）的变化，并对部分病例做了卵巢活检进行形态学研究。结果 ＡＣＭ化疗对卵巢功能影响主要为月经量减少、黄体功能不全、Ｅ_２降低、促性腺激素增高。形态学观察表明卵巢各级卵泡数量减少但雌激素受体无改变。随着化疗的结束，上述功能多数可在一年内自行恢复正常。结论 ＡＣＭ化疗仅轻度抑制卵巢功能，主要影响卵巢内卵泡的生长与发育，说明对有生育要求的年轻患者首选ＡＣＭ化疗是合适的。     

Is changing hypothalamic activity important for control of ovulation?

The activity of the hypothalamic gonadotrophin releasing hormone pulse generator in women with regular ovulatory and anovulatory menstrual cycles was assessed to see whether changes therein are important determinants of normal and impaired ovarian function. Endogenous gonadotrophin releasing hormone secretion was inferred by measurement of the pituitary luteinising hormone response by characterisation of pulsatile luteinising hormone release over eight hours on three occasions during the course of follicular development and once during the luteal stage of the same cycles. In 13 ovulatory cycles (serum progesterone concentration greater than 25 nmol/l) confirmed by ovarian ultrasonography a pronounced variability in luteinising hormone pulse patterns among subjects was compatible with ovulation. In the luteal stage of ovulatory cycles the luteinising hormone interpeak interval (85 min, range 42-125) was significantly longer than that during the early follicular (64 min, 40-103), mid-follicular (62 min, 37-107), and late follicular (59 min, 39-80) stages of the same cycles. Thus in ovulatory cycles no increase in frequency of the gonadotrophin releasing hormone pulse generator was detected during follicular development, though this activity decreased in the luteal stage. In five late follicular stage studies in which part of the preovulatory luteinising hormone surge was captured no change in pulse frequency of luteinising hormone was detected compared with the mid-follicular stage of the same cycles or when compared with the late follicular stage of other cycles when no luteinising hormone surge was captured. Though mean luteinising hormone concentrations in luteinising hormone surge series (36 IU/l) were high, the amplitude of luteinising hormone pulses (165%) was only slightly greater than during non-surge late follicular stage studies (145%). Hence no change in hypothalamic gonadotrophin releasing hormone activity is required to generate the preovulatory discharge of luteinising hormone in man, which occurs as a result of the sensitising action of rising oestradiol concentrations on pituitary responsiveness to the same hypothalamic input signal. Luteinising hormone pulse frequency, peak amplitude, and mean serum luteinising hormone concentrations in seven anovulatory cycles (progesterone concentration less than 10 nmol/l) were not different from those at comparable stages of ovulatory cycles. These data suggest that the primary abnormality in this group of regularly menstruating anovulatory women lies in the ovary rather than in the hypothalamic control of the anterior pituitary.     

子宫内膜异位症的黄体功能研究

本文通过测定子宫内膜异位症患者黄体期血清雌二醇(E_2)及孕酮(P)的浓度之高低,同时以子宫内膜组织学表现及基础体温(BBT)作对照来研究黄体功能的变化.结果证明了不孕症患者不论轻、中,重度均有黄体功能不足的表现,(血清孕酮(P)平均浓度偏低,孕酮分泌延迟)基础体温升高迟缓,子宫内膜成熟延迟。作者还进一步探讨了其发生机制及与不孕的关系,从而提出了今后治疗处理的措施以提高妊娠率.     

达英-35配合促排卵法治疗多囊卵巢综合征不孕临床观察

目的对多囊卵巢综合征不孕患者应用达英-35配合促排卵法治疗并观察其临床疗效。方法采用随机对照的方法选取我院多囊卵巢综合征不孕患者84例,将其分为对照组42例和治疗组42例。对照组单纯予达英-35治疗,治疗组患者应用达英-35结合促排卵法治疗,比较两组患者总体疗效,治疗前后血清激素水平,治疗后排卵率及受孕率。结果治疗组总有效率90.5%,优于对照组总有效率71.4%;经治疗后两组患者血清LH、T水平下降,LH/FSH比值恢复正常,与治疗前比较差异有统计学意义（P〈0.05）,但治疗后两组激素水平差异无统计学意义（P〉0.05）;治疗组在促进排卵上优于对照组（P〈0.05）,有利于有孕。结论达英-35配合促排卵法治疗多囊卵巢综合征不孕有效,且比单纯达英-35治疗效果有优势,值得在临床上推广应用。