多囊卵巢综合征(PCOS)患者在IVF-ET中发生严重卵巢过度刺激综合征(OHSS)的特点分析

目的:通过总结IVF-ET中多囊卵巢综合征(PCOS)患者应用控制性超促排卵(COH)后发生卵巢过度刺激综合征(OHSS)的特点,提出防止中、重度OHSS发生的有效措施。方法:将IVF/ICSI治疗时出现中、重度OHSS的患者根据有无PCOS史分成PCOS组和对照组。比较分析PCOS组和非PCOS组在COH中的雌激素水平、卵泡数、取卵数及发生中、重度OHSS的时间等临床资料;分析妊娠对OHSS的影响。结果:PCOS组的Gn用药总量及hCG注射日的血清E2水平比对照组低,其总卵泡数、中小卵泡数明显高于对照组,发生中、重度OHSS的时间早,妊娠可能加重OHSS病情发展。结论:卵泡总数、中小卵泡数可作为PCOS患者预测中、重度OHSS独立的重要指标,建议即使取卵前E2水平不高、获卵数不多也考虑行全胚冷冻,以阻止严重的OHSS发生。     

促性腺激素释放激素激动剂触发排卵的临床观察

目的:探讨促性腺激素释放激素激动剂(GnRH-a)触发排卵的疗效。方法:对应用氯米芬(CC)、来曲唑(LE)和/或人绝经期促性腺激素(hMG)促排卵治疗的不孕患者,卵泡成熟时给与GnRH-a(A组)或人绒毛膜促性腺激素(hCG)(B组)触发排卵,卵巢过度刺激综合征(OHSS)高危周期则给予GnRH-a,观察比较其临床结局。结果:共分析了81例患者132个促排卵周期,A、B组周期数分别为75和57,组间周期排卵率、多胎率、流产率相似(P>0.05)。周期临床妊娠率、OHSS发生率A组高于B组(P<0.05),无重度OHSS发生。结论:GnRH-a触发排卵临床妊娠率高,可有效预防重度OHSS的发生。     

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。     

重组人促卵泡激素低剂量递增方案联合宫腔内人工授精临床分析

目的:探讨重组人促卵泡激素(rhFSH)低剂量递增方案联合宫腔内人工授精(IUI)临床效果及卵巢反应预测因子。方法:选择多囊卵巢综合征、WHO II型排卵障碍及不明原因不孕患者60例,采用rhFSH(果纳芬)低剂量递增方案促排卵联合IUI,分析妊娠率、多胎妊娠率、卵巢过度刺激综合征(OHSS)发生率,并对卵巢反应预测因子加以分析。结果:①临床妊娠率28.21%,双胎妊娠率9.09%,流产率18.18%,促排卵过程中发生OHSS(轻度)1例,无三胎及以上妊娠。②促排卵成功患者与卵巢反应不良患者在体质量、体质量指数(BMI)、窦卵泡数(AFC)、rhFSH总剂量比较,差异均有统计学意义(P<0.05)。结论:rhFSH低剂量递增方案可以使排卵障碍特别是对其他促排卵药物抵抗患者获得较好的妊娠结局,促排卵结局可能受患者体质量、BMI、AFC等因素影响。     

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。     

来曲唑联合促性腺激素超促排卵用于PCOS患者行IVF-ET的临床研究

目的:研究来曲唑(LE)在多囊卵巢综合征(PCOS)患者超促排卵行IVF-ET中的应用。方法:90例PCOS患者随机分成LE组(n=49)和GnRHa长方案组(对照组,n=41),比较组间的促排卵天数、促性腺激素(Gn)使用剂量、获卵数、受精率、卵裂率、优质胚胎率、种植率和临床妊娠率以及卵巢过度刺激综合征(OHSS)发生率。结果:LE组与对照组的Gn剂量分别为18.0±6.6支和29.3±9.5支,促排卵天数分别为7.8±1.3 d和10.0±1.2 d,获卵数分别为7.9±4.1个和19.8±7.2个,MⅡ卵率分别为74.5%和82.9%,启动周期中-重度OHSS发生率4.1%(2/49)vs 29.3%(12/41),差异均具有统计学意义(P<0.05),而组间的种植率和临床妊娠率(33.3%vs27.5%和51.1%vs 48.5%)差异无统计学意义(P>0.05)。结论:LE用于PCOS超促排卵行IVF-ET与传统的GnRHa长方案相比,在不影响临床妊娠率的前提下,可以有效减少促排卵时间和Gn使用剂量,降低OHSS发生风险,具有极大的临床应用前景。     

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。     

来曲唑用于多囊卵巢综合征患者诱导排卵的系统评价

目的:系统评价来曲唑用于多囊卵巢综合征(polycystic ovary syndrome,P-COS)诱导排卵的疗效和安全性。方法:全面检索相应的中英文数据库,收集来曲唑用于PCOS患者诱导排卵的临床随机对照试验(randomized controlled trials,RCTs)。按Co-chrane系统评价方法,用系统评价专用处理软件RevMan5.0合并分析入选研究。结果:共纳入10个RCT,包括1854例患者。Meta分析显示:(1)来曲唑组周期排卵率高于克罗米芬组,HCG日子宫内膜厚度较薄,每周期成熟卵泡数少于克罗米芬组,差异有统计学意义;妊娠率、流产率两组差异无统计学意义;(2)克罗米芬抵抗的PCOS患者使用来曲唑后,周期排卵率>60%、妊娠率>30%;(3)来曲唑组周期排卵率低于促性腺激素组;妊娠率、HCG日子宫内膜厚度、流产率两组相似;来曲唑组每周期成熟卵泡数、多胎率、OHSS发生率低于促性腺激素组。结论:目前无充分证据证明,来曲唑对PCOS患者的促排卵效果优于克罗米芬,但可用来曲唑促排卵治疗对克罗米芬抵抗或促性腺激素高敏的PCOS患者,并可有效预防卵巢过度刺激综合征和多胎妊娠发生。     

来曲唑序贯氯米芬在多囊卵巢综合征患者中的应用

目的:探讨来曲唑(LE)序贯氯米芬(CC)对多囊卵巢综合征(PCOS)患者的促排卵效果。方法:分析PCOS患者共62例,72个促排周期。按促排卵方案分为LE序贯尿促性素(HMG)组和LE序贯CC组,比较两组单卵泡率、HCG日子宫内膜厚度、未成熟卵泡率、排卵率、卵泡过度刺激综合征(OHSS)发生率、临床妊娠率、多胎妊娠率及用药时间、费用的差异。结果:LE序贯HMG组和LE序贯CC组的单卵泡率分别为78.95%、88.24%,未成熟卵泡率为7.89%、2.94%,排卵率分别为89.47%、97.06%,OHSS发生率分别为5.26%、0,临床妊娠率分别为13.16%、11.76%,多胎妊娠率分别为5.26%、2.94%,差异均无统计学意义(P0.05),LE序贯HMG组HGC日子宫内膜厚度(10.27±1.92 mm)明显厚于LE序贯CC组(9.13±2.32 mm)(P0.05)。LE序贯CC组用药时间(10.00±0.00天)明显少于LE序贯HMG组(12.16±1.98天)(P0.05)。LE序贯HMG组的费用明显高于LE序贯CC组。结论:LE序贯CC与LE序贯HMG的排卵效果及妊娠率近似,OHSS发生率无明显差别,LE序贯CC用药时间更短,费用更低,但HCG日子宫内膜更薄,应用中应适当补充雌激素促进内膜生长。     

多囊卵巢综合征患者促排卵中发生卵泡未破裂黄素化综合征的临床分析

目的:探讨多囊卵巢综合征(PCOS)促排卵治疗中出现的卵泡未破裂黄素化综合征(LUFS)的原因和治疗措施。方法:PCOS不孕患者给予促排卵治疗,对治疗中发生LUFS的51例患者分别给予卵泡穿刺(29例)和针灸(22例)治疗,比较治疗后的妊娠率。结果:29例卵泡穿刺组患者,10例妊娠,妊娠率34.48%。22例针灸患者,2例妊娠,妊娠率9.09%。结论:PCOS患者促排卵治疗中发生LUFS给予卵泡穿刺术治疗效果肯定,是一种有效的治疗方法。     

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。     

促性腺激素释放激素激动剂在多囊卵巢综合征促排卵高危周期中的 …

OBJECTIVE: To evaluate the efficacy and safety of gonadotropin-releasing hormone agonist (GnRH-a) instead of hCG for triggering ovulation in high risk gonadotropin stimulating cycles of infertile polycystic ovary syndrome (PCOS) patients. METHODS: GnRH-a was given for triggering follicular final maturation and ovulation in 18 gonadotropin stimulating cycles of 14 PCOS patients with mean serum estradiol (E2) level of 8,379 +/- 2,958 pmol/L. Their outcomes and complications were analysed. RESULTS: Ovulation achieved in 15 (83.3%) treated cycles, 4 (22.2%) became pregnant. Only 1 developed moderate ovarian hyperstimulation syndrome (OHSS) and another 1 had multiple pregnancy. CONCLUSIONS: The use of GnRH-a instead of hCG in high risk gonadotropin stimulating cycles is able to successfully induce ovulation and pregnancy and decrease the incidence of severe OHSS and multiple gestation.     

难治性多囊卵巢综合征的治疗策略及结局

目的 探讨对持续无排卵的多囊卵巢综合征（ＰＣＯＳ）患者使用诱发排卵的治疗方案及其治疗效果。方法 收集氯米芬抵抗的ＰＣＯＳ患者５９例,共８１个治疗周期,分为３组：（１）促卵泡激素（ＦＳＨ）组,４９个治疗周期;（２）ＦＳＨ＋促性腺激素释放激素（ＧｎＲＨ）泵组,１３个周期;（３）常规体外受精（ＩＶＦ）组,１９个周期。前两组给予前期降黄体生成素（ＬＨ）及睾酮（Ｔ）治疗。观察用促排或超排治疗后雌二醇（Ｅ２）     

Severe ovarian hyperstimulation syndrome in a 42-year-old woman with successful pregnancy after intracytoplasmic sperm injection embryo transfer

Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic complication of ovulation induction for infertile women. It has been shown that patients suffering from OHSS are generally young because OHSS depends on the patient's ovarian reserve. Therefore, women ≥40 years of age seldom suffer from the severe form of OHSS. In the present study, we report a case of severe OHSS that occurred in a 42-year-old woman with a successful pregnancy after intracytoplasmic sperm injection (ICSI)-embryo transfer. She had been diagnosed as having polycystic ovary syndrome (PCOS). After 5 cycles of unsuccessful treatment with gonadotropins plus intrauterine insemination for her husband's asthenozoospermia, the treatment with assisted reproductive technology (ART) was indicated. In the third ART attempt, the patient was treated by ICSI-embryo transfer (ET) and she developed severe OHSS at 4 weeks' gestation. On admission, marked hemoconcentration, oligouria and hypo-albuminemia were diagnosed. A continuous autotransfusion system of ascites, which was developed to expand circulating plasma volume without exogenous albumin, was carried out for 5 h at a rate of 100–200 mL/h once a day for a total of 5 days. The course of the pregnancy was uneventful. At 37 weeks' gestation, a healthy baby boy weighing 3336 g was born by cesarean section when the patient was 43 years of age. The postoperative course was also uneventful. To the best of our knowledge, the present report describes the oldest woman showing severe OHSS. (Reprod Med Biol 2005; 4 : 265–269)     

Studies on the effects of initial injection doses of follicle stimulating hormone on the pregnancy and the ovarian hyperstimulation syndrome incidence in polycystic ovarian syndrome patients

Background:  Patients with polycystic ovarian syndrome (PCOS) are often resistant to clomiphene citrate, which causes the need for subsequent gonadotropin treatment. However, careful administration is required because of the potential side-effects, that is, ovarian hyperstimulation syndrome (OHSS) and multiple pregnancy.
Methods:  Forty-three cycles in 22 patients with PCOS were enrolled in this study. Ovarian stimulation was initiated on day 7 of the menstrual cycle with 150 IU/day of follicle stimulating hormone (FSH; 150 IU course), 100 IU/day (100 IU course), and 75 IU/day (75 IU course), successively. If follicles over 12 mm in diameter did not develop after 1 week, the dose was increased. In each treatment course, the number of developed follicles, the serum estradiol level before ovulation, total FSH dosage and duration of administration, the incidence of OHSS, and pregnancy rate were examined.
Results and Conclusion:  The largest number of developed follicles and the highest serum estradiol level were found in the 150 IU course. In contrast, the total FSH dosage and duration of administration were highest and longest in the 75 IU course. The incidence of OHSS and pregnancy rate were highest in the 150 IU course and in the 75 IU course, respectively. The present study indicates that 100 IU or 75 IU of FSH is recommended as an initial injection dose for PCOS patients. (Reprod Med Biol 2003; 2 : 63–67)     

Letrozole combined with low dose highly purified HMG for ovulation induction in clomiphene citrate-resistant infertile Chinese women with polycystic ovary syndrome: a prospective study

Background and aim: There are still open questions about ovulation induction in clomiphene citrate-(CC)-resistant infertile women. Especially little is known about efficacy and safety of letrozole (LTZ) combined with low-dose highly purified human menopausal gonadotropin (Hp-HMG) in women with polycystic ovary syndrome (PCOS).

Methods: Prospective, single-arm single-center trial in 200 infertile PCOS patients refractory for at least three CC-treatment cycles. Women with hyperandrogenism took Diane-35 for at least 3?months. All patients got LTZ on day 3 for 5?d in combination with Hp-HMG, starting with 75?IU from cycle day 7 and maintained for up to 3?d. The maximum dose was 150?IU. Primary end-points were ongoing and clinical pregnancy rate, secondary end-points mono-follicular development, ovulation rate, OHSS, multiple pregnancy and early pregnancy loss. Major safety end-point was the incidence of adverse events.

Results: Within 395 cycles the ongoing pregnancy rate was 28.24%, for cycles 35.23%, for patients 68%. The rate of ovulation per cycle was 97.7%, percentage of mono-follicular development 70.9%. No severe OHSS, multiple pregnancy, local or systemic side effects were seen.

Conclusions: LTZ combined with low-dose Hp-HMG is an effective and safe choice for reducing hyperstimulation and increasing pregnancy rate in CC-resistant women with PCOS.     

GnRH-a治疗难治性排卵障碍不孕患者的初步观察

目的探讨常规诱导排卵失败后应用促性腺激素释放激素激动剂(GnRH-a)诱导排卵的临床效果.方法对常规促排卵治疗(氯米芬和HMG)失败的13例排卵障碍不孕患者,其中多囊卵巢综合症(PCOS)5例,小卵泡排卵8例.采用GnRH-a+HMG治疗,并于周期第8天开始B超监测卵泡发育并测定尿LH,当卵泡平均径线达18 mm或尿LH(+)时,给HCG诱发排卵.结果13例患者采用GnRH-a+HMG治疗19个周期,均有优势卵泡发育,其中16个周期(84.2%)卵泡平均径线达18 mm时尿LH仍为(-),给HCG诱发排卵;3个周期提前出现LH峰,取消使用HCG.36.8%的周期为单卵泡发育,75.0%为＜3个优势卵泡,8.3%为4～10个,18.8%为＞10个.妊娠率58.3%,周期妊娠率41.2%,其中单胎4例,双胎2例,4胎1例;自然流产的发生率为14.3%.结论GnRH-a可增强PCOS患者对HMG的反应性,防止内源性LH峰早现,并有良好的妊娠率及妊娠结局,可望作为治疗PCOS及小卵泡排卵患者的二线药物;低剂量HMG可使75%的治疗周期中卵泡发育数＜3个.