卵泡穿刺配合人工授精治疗多囊卵巢综合征引起的不孕症

目的 了解阴道超声引导下卵泡穿刺后行人工授精治疗多囊卵巢综合征(polycysfic ovary syndrome，PCOS)所致不孕症的效果。方法 选择对克罗米芬治疗无反应的PCOS患者应用促排卵药治疗后，随机选择60例在阴道超声引导下卵泡穿刺后行人工授精术；另选择60例患者直接指导性生活。结果 对照组60例患者临床妊娠率23．33％，卵巢过度刺激综合征(ovarian hyperstimulation syndrome，OHSS)发生率40．00％，卵泡穿刺组60例患者临床妊娠率48．33％，OHSS发生率35．00％。结论 促排卵治疗后，阴道超声引导下卵泡穿刺配合人工授精治疗，提高了PCOS所致的不孕症患者的临床妊娠率，OHSS的发生率未降低。     

多囊卵巢综合征不孕患者未成熟卵泡抽吸术的疗效分析

目的:探讨对克罗米芬抵抗的多囊卵巢综合征(PCOS)不孕患者在超声引导下行小卵泡抽吸术(IMFA)的治疗效果。方法:将42例PCOS合并克罗米芬(CC)抵抗的不孕患者,随机分为A组:19例,穿刺前用CC或来曲唑(LE)联合少量hMG促排卵;B组:23例,穿刺前用少量hMG促排卵。在阴道B超引导下进行未成熟卵泡抽吸术(IMFA),观察穿刺前及穿刺后第2周期患者的卵巢基础窦卵泡数(AFC)、抗苗勒氏管激素(AMH)、血中游离睾酮指数(FAI)、黄体生成素与卵泡刺激素的比值(LH/FSH),以及术后并发症、3个月促排卵情况和妊娠率。结果:42例患者治疗时均没有发生卵巢过度刺激综合征(OHSS)。与治疗前比较,穿刺术后A、B组AFC显著减少,AMH、FAI和LH/FSH显著降低(P<0.01)。A、B组间比较,FAI、LH/FSH、排卵率和妊娠率无统计学差异(P>0.05)。A、B组共21例妊娠,妊娠率为50%。42例患者均没有发生出血、感染、OHSS。结论:IMFA治疗克罗米芬抵抗的PCOS不孕患者有较好的疗效,本方法安全、有效。     

克罗米芬联合促卵泡素治疗多囊卵巢综合征的疗效观察

目的:比较单用克罗米芬(CC)及其联合不同促卵泡素(FSH)治疗多囊卵巢综合征(PCOS)患者的效果,以指导PCOS患者选择合适的促排卵方案.方法:选取2009年1月至2012年7月就诊于我院生殖门诊的81例PCOS患者(共92周期),患者均以CC促排卵,根据月经第8天的卵泡生长情况,决定是否联合应用基因重组促卵泡素(rFSH)或尿促卵泡素(uFSH).按促排卵方案不同将患者分为3组:CC+ HCG组(A组,26例,32周期);CC+rFSH+HMG+HCG组(B组,23例,26周期);CC+uFSH+HMG+HCG组(C组,32例,34周期).患者排卵后均用黄体酮胶丸或地屈孕酮黄体支持12 ～ 14天.比较3组患者促排卵治疗的效果.结果:A组中2例患者发生黄素化综合征(LUFS);B组中4例发生轻度卵巢过度刺激综合征(OHSS);C组中1例发生重度OHSS,1例LUFS.3组患者的HCG日最大卵泡直径、内膜厚度、排卵率及妊娠率均无显著差异(P＞0.05).A组D8优势卵泡直径大于B、C组(P＜0.05);至HCG日平均时间少于B、C组(P＜0.05);B组直径≥1.5cm卵泡数和排卵数均显著高于A、C组(P＜0.05).B组与C组的至HCG注射日时间和FSH用量均无显著差异(P＞0.05).结论:CC促排周期D8优势卵泡直径大小对决定联合FSH治疗PCOS患者有一定的参考意义.单用CC促排卵可能抵抗周期,联合uFSH是经济有效的促排卵方案.     

PCOS患者药物促排卵中LUFS发生的相关因素

目的 探讨多囊卵巢综合征(PCOS)患者药物诱导排卵治疗中发生未破裂黄素化卵泡综合征(LUFS)的相关因素。方法 对比克罗米酚(CC)及人绝经后促性腺激素(HMG)方案用药前后PCOS患者血清PRL、FSH、LH、E_2、T水平,阴道超声检查卵巢形态,分析PCOS患者LUFS发生与基础性激素水平和卵巢形态的关系。结果 应用CC加用HCG45例,卵泡发育率66.67％,周期妊娠率为22.22％,LUFS发生率33.33％;应用CC无效者,应用HMG方案30例,卵泡发育率高(86.67％),但LUFS和过度刺激综合征(OHSS)发生率高分别为36.67％和13.33％,周期妊娠率16.67％。T水平LUFS组高于排卵组,表明LUFS的发生与血清睾酮水平有关。周边囊泡型多囊卵巢(PCP)LUFS发生率25％,普通囊泡型多囊卵巢(GCP)LUPS发生率75％。结论 普通囊泡型多囊卵巢患者易于发生卵泡黄素化不破裂综合征,可能与患者雄激素水平相对较高,卵巢包膜厚,优势卵泡不是发生在卵巢周边有关。     

多囊卵巢综合征患者促排卵后发生卵泡未破裂黄素化综合征多途径治疗的临床分析

卵泡未破裂黄素化综合征(LUFS)是指卵泡生长到一定时期并无破裂排卵，但其内部发生黄素化而引起的一系列征候群，是无排卵性月经的一种特殊类型，也是女性不孕的原因之一，属卵巢性不孕，常见于多囊卵巢综合征(PCOS)。本研究对PCOS不孕患者促排卵治疗中发生LUFS进行诊断，探讨较好的治疗方法。     

卵泡穿刺术在治疗多囊卵巢综合征中的应用

针对多囊卵巢综合征(polycystic ovarian syndrome,PCOS)促排卵中出现的多卵泡发育及排卵障碍,卵泡穿刺技术逐渐成为一种新型的治疗手段,被越来越多的患者采用。其具有创伤小、疗效确切、简便等优点,可用于治疗耐克罗米芬的PCOS不育患者、卵巢过度刺激综合征(OHSS)的PCOS患者、未破裂卵泡黄素化综合征(LUFS)的PCOS患者等。能纠正PCOS患者的异常内分泌相,恢复自然排卵,缩短月经周期及降低窦卵泡数,但在治疗中因某些原因不能及时进行下一步的治疗(6~8个月),会重新出现窦卵泡数上升,LH/FSH>2等表现,因此,术后需及时配合药物治疗,以获得满意疗效。     

针灸联合宫内人工授精(IUI)治疗多囊卵巢综合征所致不孕——65例疗效观察

目的:观察针灸与药物促排卵配合宫腔内人工授精(IUI)治疗多囊卵巢综合征(PCOS)所致不孕的临床疗效。方法:125例PCOS患者随机分为2组:治疗组65例,在药物促排卵基础上于IUI术前、后加针灸治疗;对照组60例,在IUI术前单以药物促排卵治疗。结果:治疗组的周期排卵率为83.9%,妊娠率为36.9%,黄素化未破裂卵泡(LUF)发生率为4.1%,周期取消率为6.3%;对照组周期排卵率为69.9%,妊娠率为20%,LUF发生率为23.1%,周期取消率为21.4%,组间比较均有显著差异(P<0.05或P<0.01)。结论:针灸配合IUI治疗PCOS可有效提高临床妊娠率,降低了LUF及卵巢过度刺激综合征(OHSS)等并发症的发生率。     

戈那瑞林(GnRH)在多囊卵巢综合征患者中的促排卵作用

目的:探讨国产戈那瑞林(GnRH)预防多囊卵巢综合征(PCOS)不孕患者中促排卵后卵巢过度刺激综合征(OHSS)发生的临床价值。方法:PCOS不孕患者14例,常规使用氯米氛和hMG/FSH促进卵泡发育,当卵泡直径≥18mm时给予戈那瑞林100μg(皮下注射)诱发排卵,指导当天同房;阴道超声证实排卵后给予黄体酮20mg/d肌注,16d后复诊。观察排卵率、妊娠率、OHSS和多胎妊娠的发生率。结果:排卵率85.7%,妊娠率50%,其中1例多胎妊娠出现中度OHSS,但无重度OHSS的发生。结论:戈那瑞林(GnRH)可降低PCOS患者诱发排卵时中、重度OHSS的发生。     

阿司匹林对多囊卵巢综合征患者临床妊娠率影响的初步研究

目的:初步探讨阿司匹林对多囊卵巢综合征(PCOS)患者临床妊娠率的影响。方法:选择门诊确诊的PCOS患者90例及健康育龄妇女40例(对照组),监测体质量指数(BMI)、超敏C反应蛋白(CRP)及相关性激素。将PCOS患者随机分为氯米芬组,单用氯米芬促排卵治疗(n=40)和阿司匹林联合氯米芬组,先使用阿司匹林治疗3个月后,再联合氯米芬促排卵治疗(n=50)。检测用药治疗3个月前、后的BMI、CRP及相关性激素等指标。检测PCOS组促排卵治疗后hCG注射日子宫内膜厚度,并计算各组卵泡黄素化未破裂综合征(LUFS)发生率与临床妊娠率。结果:PCOS患者CRP水平明显高于对照组(P0.05);PCOS患者经阿司匹林治疗后CRP水平明显下降(P0.05);氯米芬组与阿司匹林联合氯米芬组的临床妊娠率分别为12.5%和31.9%(P0.05)。结论:阿司匹林可以降低PCOS患者CRP水平、改善性激素水平异常、降低LUFS的发生率等,从而提高临床妊娠率。     

卵泡穿刺抽吸在治疗多囊卵巢综合不育患者中临床意义初探

目的:探讨卵泡穿刺抽吸对多囊卵巢综合征(PCOS)不孕患者卵巢窦卵泡计数及妊娠的影响。方法:将74例行人绝经期促性腺激素(hMG)促排卵的PCOS患者随机分为二组,观察组37例,于卵泡直径达9-10mm时行卵泡穿刺抽吸;对照组37例,仅行常规促排卵,连续观察6个月,观察穿刺治疗前后性激素FSH、LH、T、E2、PRL水平的变化,比较二组患者卵巢窦卵泡计数及妊娠情况。结果:穿刺抽吸组与治疗前比较,11例患者的血清LH/FSH降低,T、E2、PRL水平无明显变化,29例患者卵巢基础窦卵泡计数降至10个/卵巢以下,无一例发生卵巢过度刺激综合征(OHSS),6个月内14例妊娠;对照组患者的血清性激素水平无明显变化,卵巢基础窦卵泡计数仍为10个/卵巢以上,发生OHSS者3例,6个月内仅3例妊娠。结论:常规治疗无效的PCOS不孕患者,行卵泡穿刺抽吸为有效治疗途径。     

不孕合并卵泡黄素化不破裂综合征临床治疗分析

目的：研究卵泡穿刺和药物促排卵两种治疗方法对不孕合并卵泡黄素化不破裂综合征患者的临床治疗效果。方法：于我院选取卵泡黄素化不破裂综合征患者68例，随机分为两组，实验组在注射人绒毛膜促性腺激素后进行卵泡穿刺治疗，对照组采用人绒毛膜促性腺激素和曲普瑞林药物进行治理，治疗后两组均采用人工授精，对比治疗3个周期后两组排卵率、妊娠率和流产率。结果：实验组临床妊娠率为47．05％，对照组临床妊娠率为23．53％，实验组优于对照组（P〈0．05），有统计学差异。结论：卵泡穿刺法治疗不孕合并卵泡黄素化不破裂综合征疗效显著，值得临床进一步推广。     

二甲双胍治疗耐克罗米芬的多囊卵巢综合征40例分析

目的：观察二甲双胍单用或联合高纯度卵泡刺激素（metrodin-HP即FSH－HP）治疗耐克罗米芬（CC)多囊卵巢综合征（PCOS）患者的疗效。方法：选择耐CC的PCOS患者40例，随机分成A组和B组。A组：20例患者从卵泡早期开始服二甲双胍，每天1500mg共12周，若未孕则加FSH－HP促排卵1个周期，B组；20例患者单独用FSH－HP促排卵1个周期。测定所有患者的性激素、空腹血糖（FG）及空腹胰岛素（FINS）。结果：服二甲双胍后，LH、T及FINS的水平明显下降（P＜0．05），A组有7例患者排卵且3例妊娠，妊娠率为15．0％，17例未孕者继续服二甲双胍联合FSH－HP促排卵，15例排卵和4例妊娠，妊娠率23．5％，B组单用FSH－HP促排卵，有14例排卵且3例妊娠，妊娠率15．0％，两者的妊娠率差异无显著性意义（P＞0．05）。A组的FSH－HP用量少于B组，差异有显著性意义（P＜0．05），中度以上OHSS发生率分别为0和10％，前者的发生率低于后者（P＜0．05）。结论：单用二甲双胍能使部分患者恢复排卵和妊娠。FSH－HP联合二甲双胍能减少FSH－HP的用量和OHSS的发生。二甲双胍单用或联合FSH－HP促排卵为耐CC的PCOS患者找到一种有效的治疗方法。     

Pulsatile intravenous gonadotropin-releasing hormone for ovulation-induction in infertile women. I. Safety and effectiveness with outpatient therapy

Pulsatile intravenous gonadotropin-releasing hormone (IV-GnRH) was used in 36 infertile patients with primary amenorrhea (n = 5), secondary amenorrhea due to hypothalamic chronic anovulation (HCA) (n = 22), hyperprolactinemia (n = 1) or polycystic ovary syndrome (PCOS) (n = 5), and oligomenorrhea (n = 3). Treatment was commonly initiated in the hospital but was then continued outside, with patients and local physicians accepting responsibility for maintaining IV-GnRH delivery systems. Twenty-eight of 113 treatment cycles (24.8%) resulted in pregnancy, with four spontaneous abortions (14.3%) and four twin pregnancies (16.7%) among 24 births. Probability of pregnancy per treatment cycle was significantly higher for primary amenorrhea (0.30) and for HCA (0.33) than for PCOS (0.07; P less than 0.05) and for oligomenorrhea (no conceptions; P = 0.01). Ovulatory cycles were not achieved in five patients (primary amenorrhea, n = 1; PCOS, n = 3; oligomenorrhea, n = 1). There were no serious complications; six patients recorded eight febrile episodes, which responded quickly to antibiotic therapy and cannula change. The authors conclude that outpatient IV-GnRH is safe, practical, and effective for follicular stimulation and ovulation induction in women presumed to have GnRH deficiency and in whom clomiphene therapy fails, and that less intensive monitoring is needed compared with gonadotropin ovulation induction therapy.     

The effectiveness of metformin ovulation induction treatment in patients with PCOS: a systematic review and meta-analysis

Objective: To evaluate of metformin effectiveness of ovulation induction treatment in polycystic ovary syndrome (PCOS) women. Methods: Eight databases and nine related journals were searched for randomized controlled trails (RCTs) on the comparison between metformin and clomiphene citrate used for PCOS women. Meta analysis was performed after quality assessment. Results: Ovulation rate in metformin group compared with clomiphene citrate group was lower with a significant difference [OR = 0.48 (0.26–0.87), p = 0.01]; no significant difference was found for pregnancy rate [OR = 0.94 (0.26–3.43)], miscarriage rate [OR = 0.63 (0.06–6.47)] between two groups. Compared with the combination of metformin and clomiphene citrate group, pregnancy rate in metformin group was significantly lower [Peto OR = 1.56 (1.16–2.08), p = 0.003], but there was no significant difference in the two groups about ovulation rate [OR = 1.52 (0.95–2.45)], miscarriage rate [Peto OR = 1.40 (0.79–2.48)]. Conclusions: Compared with clomiphene citrate, metformin used for ovulation induction treatment in PCOS women, can promote ovulation induction and pregnancy rate, the effect of the combination treatment is better than that of a single drug use.     

来曲唑联合克罗米芬治疗多囊卵巢综合征患者的疗效及对排卵、妊娠情况的影响#br#

Objective?To investigate the clinical effect of letrozole (LE) combined with clomiphene (CC) in the treatment of polycystic ovary syndrome (PCOS). Methods?A total of 120 patients with PCOS were selected as the research objects, of which 60 patients who received single CC treatment were the control group, while the combined group (60 patients) was given LE+CC treatment. Menstrual conditions and sex hormone levels [luteinizing hormone (LH), estradiol (E2), and progesterone (P)] were compared between the two groups, and ovulation and pregnancy were recorded in the two groups. Results?The number of mature follicles, endometrial thickness, menstrual cycle, menstrual volume and early abortion rate in the combined group were lower than those in the control group (P<0.05). After treatment, E2, LH, P secretion levels, ovulation rate, pregnancy rate and twin rate in the combined group were higher than those in the control group (P<0.05). Conclusion? LE combined with CC in the treatment of PCOS patients can achieve better efficacy in ovulation induction and pregnancy.     

腹腔镜治疗难治性多囊卵巢综合征不孕患者38例临床分析

目的:探讨腹腔镜对难治性多囊卵巢综合征(PCOS)不孕的治疗效果。方法:2001年3月至2005年5月对我院诊治的38例难治性PCOS不孕症患者,行腹腔镜下卵巢多点打孔术及盆腔粘连松解、输卵管整形术。手术前后分别测血清黄体生成素(LH)、卵泡刺激素(FSH)、雄激素(T)及雌二醇(E2)水平;术后监测排卵情况、妊娠率及妊娠结果。结果:术后血LH和T水平较术前有显著性下降(P<0.01)。术后排卵率81.6%(31/38),1年内累计妊娠18例,妊娠率为47.3%(18/38),早期流产率为16.7%(3/18)。有4例术后3个月内予氯米芬(CC)1~2个疗程后恢复月经外,其余月经情况(经量及持续时间)较术前均有明显改善。结论:腹腔镜卵巢多点打孔术能明显改善难治性PCOS患者的排卵和受孕机会,相对于单纯促排卵药物治疗具有术后排卵率高、妊娠率高、流产率低的优点,尤其对难治性PCOS不孕患者不失为一个有效治疗手段。     

Risk of multiple gestation after ovulation induction in polycystic ovary syndrome

OBJECTIVE: To compare the incidence of multiple gestation following treatment with clomiphene citrate (CC), metformin (MET) or gonadotropins in polycystic ovary syndrome (PCOS) patients undergoing ovulation induction. STUDY DESIGN: This was a retrospective, cohort study performed in an academic reproductive endocrine practice. PCOS patients presenting for first-trimester ultrasound were identified and assigned to 1 of 3 groups: CC-resistant patients who conceived after use of metformin +/- CC (group A), CC-resistant patients who conceived after gonadotropins (group B) and PCOS patients who conceived with CC only (group C). Multiple pregnancy outcome data were collected by chart review and patient interview. RESULTS: One hundred one pregnancies were identified in PCOS patients who had conceived after ovulation induction (OI). The rate of multiple gestation was higher in group B (36%) than in A (0%) or C (11%). CONCLUSION: The rate of multiple births was significantly lower with MET use during OI. Because multiple gestation is associated with higher complication rates and medical costs, our data offer an additional reason for use of MET for OI in PCOS patients who fail CC.