预测多囊卵巢综合征促排卵治疗结局的研究

目的 探讨影响多囊卵巢综合征（ＰＣＯＳ）患者促排卵治疗结局的相关因素,建立分类树分析（ＣＡＲＴ）模型。方法 采用放射免疫方法,测定１０３例ＰＣＯＳ患者及３１例正常妇女血清雌二醇（Ｅ２）、睾酮（Ｔ）、雄烯二酮（Ａ）、促卵泡激素（ＦＳＨ）、黄体生成素（ＬＨ）、垂体泌乳素（ＰＲＬ）水平,进行口服糖耐量试验及胰岛素释放试验,应用氯米芬（ＣＣ）／人绒毛膜促性腺激素（ｈＣＧ）、ＣＣ／人绝经期促性腺激素（ｈＭＧ     

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。     

多囊卵巢综合征患者血清生长激素和泌乳素对左旋多巴反应的…

目的：探讨多囊卵巢综合征（ＰＣＯＳ）患者生长激素（ＧＨ）和泌乳素（ＰＲＬ）异常分泌的机理。方法：对黄体生成素）ＬＨ）／卵泡刺激素（ＦＳＨ）≥３的１５例患者（Ⅰ型组）、ＬＨ／ＦＳＨ〈３的１５例患者（Ⅱ型组）以及２０例月正常妇女（对照组），行左旋多巴（ＬＤ，５５００ｍｇ）兴奋下丘脑－垂体轴功能试验，观察３组ＧＨ和ＰＲＬ的浓度变化。结果：在上，Ⅰ、Ⅱ型组的ＧＨ较低、ＰＲＬ较高；Ｌ－ＤＡ兴奋试验后，Ⅰ、Ⅱ     

多囊卵巢综合征患者用克罗米酚促排卵结局与相关因 …

目的 探讨在多囊卵巢综合征（ＰＣＯＳ）患者中影响克罗米酚（ＣＣ）促排卵因素。方法 对９４例因多囊卵巢综合征不孕患者,用ＣＣ促排卵治疗。采用放射免疫方法测定卵泡刺激素（ＦＳＨ）,黄体生成素（ＬＨ）,雌二醇（Ｅ２）、睾酮（Ｔ）,雄烯二酮（Ａ）,泌乳素（ＰＲＬ）水平及胰岛素释放反应。分析了卵结局与年龄,基础激素水平、胰岛素抵抗（ＩＲ）、胰岛素反应曲线下面积（ＡＵＣ１）及体重指数（ＢＭＩ）之间的关系。结果     

罗格列酮用于多囊卵巢综合征促排卵治疗的效果观察

目的　探讨罗格列酮 (rosiglitazone)对存在胰岛素抵抗的多囊卵巢综合征 (polycysticovarysyndrome ,PCOS)患者促排卵治疗的效果。 方法　选择存在胰岛素抵抗的PCOS患者 96例 ,将其随机分为A、B、C组。A组 (2 8例 )口服氯米芬、B组 (3 2例 )口服罗格列酮、C组 (3 6例 )口服罗格列酮联合氯米芬 ,3组用药时间均为 3个月经周期。比较 3组用药前后的胰岛素抵抗指数的变化和排卵情况。结果　B组和C组患者治疗后 ,应用稳态模型评估的胰岛素抵抗指数 (homeostasismodelassessmentinsulinresistance ,HOMAIR)分别由 1 2± 0 6、1 1± 0 5下降为 0 6± 0 2、0 6± 0 4,两组治疗前后比较 ,差异也有显著性 (P <0 0 5)。C组治疗后排卵率为 80 % ,明显高于A组的 59%和B组的 3 5% ,差异有显著性 (P <0 0 5)。结论　罗格列酮能有效地改善胰岛素抵抗 ,提高促排卵治疗的成功率     

多囊卵巢综合征患者血清生长激素和泌乳素对左旋多巴反应的研究

目的：探讨多囊卵巢综合征（ＰＣＯＳ）患者生长激素（ＧＨ）和泌乳素（ＰＲＬ）异常分泌的机理。方法：对黄体生成素（ＬＨ）／卵泡刺激素（ＦＳＨ）≥３的１５例患者（Ｉ型组）、ＬＨ／ＦＳＨ＜３的１５例患者（Ⅱ型组）以及２０例月经周期正常妇女（对照组），行左旋多巴（Ｌ－ＤＡ，５００ｍｇ）兴奋下丘脑－垂体轴功能试验，观察３组ＧＨ和ＰＲＬ的浓度变化。结果：在基础状态下，Ⅰ、Ⅱ型组的ＧＨ较低（Ｐ＜０．０１）、ＰＲＬ较高（Ｉ型组，Ｐ＜０．０５）；Ｌ－ＤＡ兴奋试验后，Ⅰ、Ⅱ型组ＧＨ的升高程度和ＰＲＬ的下降程度均低于对照组。结论：ＰＣＯＳ的ＧＨ和ＰＲＬ异常分泌可能与其中枢ＤＡ活性不足有关。     

重组基因的促卵泡生长素诱导多囊卵巢综合征患者排卵的临床分析

对多囊卵巢综合症 (ＰＣＯＳ)不育患者应用针剂促排卵 ,容易发生卵巢过度刺激症状和多胎妊娠。2 0世纪 90年代后 ,促排卵药物趋向于基因重组的促卵泡生长素(ｒ ＦＳＨ) [1 3] 。本研究对ＰＣＯＳ患者应用ｒ ＦＳＨ逐渐递增剂量法诱导排卵。现报道如下。一、资料和方法1.研究对象 :为 43例澳大利亚籍ＰＣＯＳ患者。患者在澳大利亚墨尔本Ｍｏｎａｓｈ医院确诊为ＰＣＯＳ后 ,检查输卵管通畅 ,男方精液正常 ,以单纯排卵障碍进入Ｍｏｎａｓｈ不育中心进行了 99个周期的诱导排卵治疗。其中 2 3例为原发性不育 ,2 0例为继发性不育。 43例中有 2 7例…     

促排卵治疗对多囊卵巢综合征患者子宫内膜整合素αv,β3表？…

目的 了解促排卵药物对多囊卵巢综合征（ＰＣＯＳ）患者黄体中期子宫内膜整合素αｖ、β３表达的影响。方法 应用单克隆抗体,采用免疫组织化学技术对２２例正常妇女、４０例无排卵ＰＣＯＳ患者促排卵治疗后黄体中期的子宫内膜整合素αｖ、β３进行测定。结果正常妇女子宫内膜整合素αｖ、β３表达在“着床窗口期”呈现强阳性;而氯米芬（ＣＣ）及绝经期促性腺激素（ｈＭＧ）抑制αｖ、βｂ的表达,使其表达呈弱阳性;而促性腺素释     

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应用

目的探讨促性腺激素释放激素激动剂（ＧｎＲＨａ）代替ｈＣＧ在多囊卵巢综合征（ＰＣＯＳ）中诱发排卵治疗的效果及并发症。方法对采用绝经期促性腺激素或卵泡刺激素促排卵治疗的１４例ＰＣＯＳ患者（１８个周期）,于卵泡≥１８ｍｍ时给予ＧｎＲＨａ,观测血清雌二醇（Ｅ２）水平、排卵率、妊娠率、卵巢过度刺激综合征（ＯＨＳＳ）和多胎妊娠发生情况。结果１４例１８个治疗周期给予ＧｎＲＨａ日血清Ｅ２为（８３７９±２９５８）ｐｍｏｌ／Ｌ,周期排卵率和妊娠率分别为８３３％和２２２％。中度ＯＨＳＳ和多胎妊娠各１例。结论在ＰＣＯＳ不孕患者中以ＧｎＲＨａ代替ｈＣＧ具有相似的排卵率和妊娠率,但能明显降低ＯＨＳＳ发生率,减少多胎妊娠。     

芳香化酶抑制剂在多囊卵巢综合征促排卵治疗中的应用

多囊卵巢综合征（PCOS）临床表现以月经稀发的慢性或持续无排卵、高雄激素血症和卵巢多囊变为特征。虽然有关其病理生理研究较多，但确切的发病机制至今尚不清楚。枸橼酸氯米酚（clomiphene citrate，CC）常作为PCOS的一线促排卵药物诱发排卵。虽其促排卵率可高达75％-80％，但使用6个周期的累计妊娠率却仅为40％～45％。另有报道20％～25％的妇女存在CC抵抗。对CC治疗6个周期无效者，临床上常选用促性腺激素（HMG或r—FSH）促排卵。[第一段]     

二甲双胍在多囊卵巢综合征促排卵治疗中的作用

目的　评估二甲双胍在多囊卵巢综合征 (PCOS)患者促排卵治疗中的作用。方法　以40例PCOS患者 (PCOS组 )为研究对象 ,其中 2 0例口服二甲双胍治疗 12周 ,治疗后 17例未孕者加用高纯度促卵泡激素 (FSH HP)治疗 1个周期 (A组 ) ,另 2 0例单用FSH HP治疗 1个周期 (B组 ) ;同时 ,以体重和月经周期均正常的 2 0例门诊患者为对照组。观察各组及A组患者口服二甲双胍前后血清FSH、黄体生成激素 (LH)、睾酮、瘦素、空腹血糖及空腹胰岛素水平 ;比较A、B两组促排卵治疗结果。结果　空腹胰岛素和瘦素水平 ,PCOS组显著高于对照组 (P <0 .0 5) ,PCOS肥胖者高于PCOS非肥胖者(P <0 .0 5) ,但PCOS非肥胖者与对照组相比 ,差异无显著性 (P >0 .0 5)。二甲双胍治疗后 ,LH、空腹胰岛素、睾酮及瘦素水平明显下降 (P <0 .0 5～ 0 .0 1)。PCOS组患者中有 3例服二甲双胍治疗期间妊娠 ,另外 3 7例行FSH HP促排卵治疗后有 7例妊娠 (A组 4例 ,B组 3例 ) ,总妊娠率为 19% ( 7 3 7) ;A组的排卵率 ( 88% ,15 17)和妊娠率 ( 2 4% ,4 17)虽高于B组 ( 70 % ,14 2 0 ;15% ,3 2 0 ) ,但差异无显著性 (P >0 .0 5)。结论　二甲双胍能降低胰岛素和瘦素水平 ,逆转PCOS患者性激素异常 ,使部分患者恢复排卵和妊娠 ,可增强PCOS患者对促性腺素的敏感     

Reproductive outcome after letrozole versus laparoscopic ovarian drilling for clomiphene-resistant polycystic ovary syndrome

Objective

To compare the clinical outcomes of letrozole and laparoscopic ovarian drilling (LOD) in patients with clomiphene-citrate-resistant polycystic ovary syndrome (PCOS).

Methods

In the present prospective randomized trial, 140 women with clomiphene-citrate-resistant PCOS were randomly allocated to receive 5 mg letrozole from day 3 to day 7 of menses for 6 consecutive cycles, or to undergo LOD. When a leading follicle of at least 18 mm was present, ovulation was triggered with human chorionic gonadotropin (hCG). The 6-month rates of ovulation, pregnancy, abortion, and live births were evaluated.

Results

The groups were similar with regard to baseline clinical characteristics and hormonal profiles. The ovulation rate was significantly higher in the letrozole group than in the LOD group (59.0% versus 47.5%). On the days of the hCG injection, women in the letrozole group had a significantly thicker endometrium than those in the LOD group (P < 0.0001). Women receiving letrozole had a higher pregnancy rate (35.7% versus 28.6%) and a lower rate of spontaneous abortion (8.0% versus 20.0%, respectively), but these differences were not statistically significant.

Conclusion

Letrozole seems to be a suitable second-line ovulation-inducing alternative to LOD in women with PCOS who do not conceive with clomiphene citrate.     

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）     

Myo-inositol in patients with polycystic ovary syndrome: A novel method for ovulation induction

Background. Polycystic ovary syndrome (PCOS) is often characterized by chronic oligo- or anovulation (usually manifested as oligo- or amenorrhea), and hyperandrogenism. In addition, 30–40% of PCOS women have impaired glucose tolerance, and a defect in the insulin signaling pathway (inositol-containing phosphoglycan mediators) seems to be implicated in the pathogenesis of insulin resistance. PCOS patients are subfertile as a consequence of such ovulatory disorders and often need drugs, such as clomiphene citrate or follicle-stimulating hormone, for ovulation induction, which increases the risk of multiple pregnancy and ovarian hyperstimulation syndrome. We hypothesized that the administration of an isoform of inositol (myo-inositol), belonging to the vitamin B complex, would improve the insulin-receptor activity, restoring normal ovulatory function.

Materials and methods. Twenty-five PCOS women of childbearing age with oligo- or amenorrhea were enrolled in the study. Ovulatory disorder due to PCOS was apparently the only cause of infertility; no tubal defect or deficiency of male semen parameters was found. Myo-inositol combined with folic acid (Inofolic®) 2 g twice a day was administered continuously. During an observation period of 6 months, ovulatory activity was monitored with ultrasound scan and hormonal profile, and the numbers of spontaneous menstrual cycles and eventually pregnancies were assessed.

Results. Twenty-two out of the 25 (88%) patients restored at least one spontaneous menstrual cycle during treatment, of whom 18 (72%) maintained normal ovulatory activity during the follow-up period. A total of 10 singleton pregnancies (40% of patients) were obtained. Nine clinical pregnancies were assessed with fetal heart beat at ultrasound scan. Two pregnancies evolved in spontaneous abortion.

Conclusion. Myo-inositol is a simple and safe treatment that is capable of restoring spontaneous ovarian activity and consequently fertility in most patients with PCOS. This therapy did not cause multiple pregnancy.     

Pregnancies following use of metformin for ovulation induction in patients with polycystic ovary syndrome

OBJECTIVE: To assess pregnancy outcome in anovulatory infertility patients diagnosed with polycystic ovary syndrome (PCOS) who were treated with metformin. DESIGN: Case series. SETTING: Outpatient. PATIENT(S): Anovulatory patients (n = 48) with a diagnosis of PCOS based on clinical, diagnostic, and laboratory evaluations were enrolled in the study over a 15-month period. INTERVENTION(S): Metformin was started at 500 mg b.i.d. for 6 weeks and then increased to 500 mg t.i.d. if no ovulation occurred. Clomiphene citrate (CC; 50 mg) was added if no ovulatory response occurred after 6 weeks. MAIN OUTCOME MEASURE(S): Resumption of menses, presumptive ovulation, and pregnancy. RESULT(S): Nineteen of 48 (40%) patients resumed spontaneous menses following treatment and showed presumptive evidence of ovulation with metformin alone; 15/48 (31%) required CC (50 mg) in conjunction with metformin therapy, and 10 of these 15 (67%) had evidence of ovulation; 20/48 (42%) conceived with a median time to conception of 3 months, and 7 of these 20 (35%) had spontaneous abortions (SAB); 19/48 (40%) had gastrointestinal-related side effects, and 5 of 48 patients (10%) had to decrease the dosage of metformin. Only 1 patient discontinued therapy. CONCLUSION(S): Metformin alone in patients with PCOS results in a substantial number of pregnancies, with 69% (20/29) of those who ovulated conceiving in less than 6 months.     

多囊卵巢综合征伴催乳素水平升高不孕患者的药物治疗效果分析

目的 探讨多囊卵巢综合征(PCOS)伴催乳素水平升高不孕患者的药物治疗方案及效果.方法 回顾性分析2005年1月至2007年3月在山东大学附属省立医院生殖医学中心就诊的PCOS伴催乳素水平升高不孕患者63例.根据溴隐亭使用的方案不同分为两组,Ⅰ组48例,溴隐亭治疗初始剂量为5mg/d,使催乳素水平维持正常后逐渐减少溴隐亭用量(每天减少1.25 mg)至溴隐亭维持量为1.25～2.5 mg/d,至少3周.然后于月经第3～5天,加用枸橼酸氯米芬(CC)促排卵治疗,CC用药期间溴隐亭用量继续维持在1.25-2.5 mg/d,月经第9天B超检查若无优势卵泡生长则加用尿促性素(hMG)75U/d,直至卵泡直径达18mm时,改用人绒毛膜促性腺激素(hCG)6000～10000 IU,hCG用药后第2天及第3天指导同房或行人工授精;Ⅱ组15例,溴隐亭初始治疗剂量同Ⅰ组,并在开始溴隐亭治疗的同时进行促排卵药物治疗,用法也同Ⅰ组.分析两组促排卵用药剂量和治疗效果.结果 Ⅰ组与Ⅱ组在指导同房周期中比较,hMG用药天数平均减少5d,差异有统计学意义(P=0.004).Ⅰ组与Ⅱ组在人工授精周期中比较,hMG用药天数平均也减少5d,差异也有统计学意义(P=0.009).Ⅰ组妊娠率为40%(19/48)高于Ⅱ组的27%(4/15),但两组比较,差异无统计学意义(x2=0.403,P=0.525).结论 对于伴催乳素水平升高的PCOS不孕患者,先用溴隐亭治疗可以减少促排卵药物使用剂量及时间;溴隐亭和促排卵药物同时治疗可减少不孕症治疗的时间.     

腹腔镜卵巢打孔术结合药物促排卵治疗难治性多囊卵巢综合征的临床研究

目的　探讨腹腔镜卵巢打孔术 (LOD)后结合克罗米芬 (CC)和中药排卵汤对难治性多囊卵巢综合征(PCOS)不孕的治疗效果。方法　 1998年 2月至 2 0 0 3年 4月将 5 8例患者随机分成A组 (LOD) 18例 ,B组(LOD CC) 2 1例及C组 (LOD CC 排卵汤 ) 19例 ,所有患者进行LOD。手术前后分别测血黄体生成激素、卵泡刺激素、雄激素及雌二醇水平 ,术后第 9天起监测患者卵泡发育和排卵共 3个周期 ,并记录妊娠数和流产数。结果　三组患者术后LH和T水平与术前相比均有显著性下降 (P <0 0 1)。 3个治疗周期内共有 4 5例排卵 ,其中A组 9例 (5 0 0 % ) ,B组 19例 (90 5 % ) ,C组 17例 (89 5 % ) ,三组间排卵率差异有显著性意义 (P <0 0 0 5 )。1年内累计妊娠 2 6例 ,其中A组 3例 ,B组 10例 ,C组 13例。自然流产A组有 1例 ,B组 2例 ,C组无发生。结论　LOD后结合CC和中药排卵汤能明显改善难治性PCOS患者的排卵和受孕机会。     

Prospective,randomized comparison between pulsatile GnRH therapy and combined gonadotropin (FSH + LH) treatment for ovulation induction in women with hypothalamic amenorrhea and underlying polycystic ovary syndrome

Objective(s)

To compare the efficacy of pulsatile GnRH therapy versus combined gonadotropins for ovulation induction in women with both hypothalamic amenorrhoea and polycystic ovarian syndrome (HA/PCOS) according to their current hypothalamic status.

Study design

This single-centre, prospective, randomized study was conducted in the Nantes University Hospital, France. Thirty consecutive patients were treated for ovulation induction with either pulsatile GnRH therapy or combined gonadotropins (rFSH + rLH). Frequency of adequate ovarian response (mono- or bi-follicular) and clinical pregnancy rate were then compared between both groups.

Results

Ovarian response was similar in both groups with comparable frequency of adequate ovarian response (73% vs 60%), but the clinical pregnancy rate was significantly higher in the pulsatile GnRH therapy group than in the combined gonadotropin group (46% vs 0%).

Conclusions

HA/PCOS is a specific subgroup of infertile women. Pulsatile GnRH therapy is an effective and safe method of ovulation induction that can be used successfully in these patients.