来曲唑和枸橼酸氯米芬诱导多囊卵巢综合征患者排卵疗效分析

目的评价多囊卵巢综合征患者使用来曲唑和枸橼酸氯米芬诱导排卵的有效性。方法全面检索相关的中英文数据库,提取数据资料,应用系统评价专用处理软件RevMan4．2进行人选研究的同质性检验和数据的合并分析。结果共5篇文献被纳入。来曲唑组和枸橼酸氯米芬组妊娠率比较相对危险度1．46（0．87～2．44）,P=0．15;排卵率相对危险度0．96（0．90～1．03）,P=0．22,均无显著性差异;对枸橼酸氯米芬抵抗和反应不良的多囊卵巢综合征患者使用来曲唑妊娠率更高,相对危险度2．12（1．14～3．97）,P=0．02,差异有显著性。来曲唑组注射绒毛膜促性腺素日雌二醇水平更低,差异有显著性（P=0．0003）。≥18mm卵泡数、注射绒毛膜促性腺素日子宫内膜厚度和流产率无显著性差异（P=0．43,P=0．43,P=0．66）。结论多囊卵巢综合征患者使用来曲唑和枸橼酸氯米芬诱导排卵的疗效没有显著差异,尚无充分证据证明来曲唑的疗效优于枸橼酸氯米芬,需要进行更多的临床研究。     

戊酸雌二醇、炔雌醇环丙孕酮联合克罗米芬胶囊治疗多囊卵巢综合征80例观察

摘 要 目的：探讨戊酸雌二醇、炔雌醇环丙孕酮片联合克罗米芬胶囊对多囊卵巢综合征不孕症患者的治疗效果。方法: 多囊卵巢综合征不孕患者80例分为观察组和对照组,每组40例。对照组给予炔雌醇环丙孕酮片和克罗米芬胶囊治疗,观察组给予戊酸雌二醇片、炔雌醇环丙孕酮片和克罗米芬胶囊治疗,共4个月经周期。比较两组多囊卵巢综合征不孕患者临床表现,促卵泡素、黄体生成素和睾酮分泌情况,子宫内膜厚度,妊娠率和排卵率。结果: 治疗后,两组多毛、痤疮和月经失调的发生率均低于治疗前（P<0.05）,但两组间比较差异无统计学意义（P>0.05）;两组黄体生成素、睾酮和黄体生成素/促卵泡素水平明显低于治疗前（P<0.05）,但两组促卵泡素水平治疗前后无明显差异（P>0.05）,且两组黄体生成素、睾酮和黄体生成素/促卵泡素水平比较也无明显差异（P>0.05）。月经第5天,两组患者子宫内膜厚度比较差异无统计学意义（P>0.05）,而围排卵期,观察组子宫内膜厚度大于对照组（P<0.05）。观察组妊娠率高于对照组（65.0% vs. 35.0%,P<0.05）,两组排卵率比较差异无统计学意义（P>0.05）。结论:炔雌醇环丙孕酮片和克罗米芬胶囊与戊酸雌二醇、炔雌醇环丙孕酮片联合克罗米芬胶囊治疗均可降低多囊卵巢综合征不孕症患者的多毛、痤疮和月经失调症状,降低血清黄体生成素、睾酮和黄体生成素/促卵泡素。戊酸雌二醇、炔雌醇环丙孕酮片和克罗米芬胶囊治疗还可促进子宫内膜生长和提高妊娠率。     

多囊卵巢综合征患者用克罗米酚促排卵结局与相关因素的探讨

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。分析了排卵结局与年龄、基础激素水平、胰岛素抵抗 (IR)、胰岛素反应曲线下面积 (AUCI)及体重指数 (BMI)之间的关系。结果　用克罗米酚促排卵 94个周期中排卵率为 5 5 2 % (5 2 / 94) ,未排卵组的基础血雄激素、LH、AUCI 和BMI均较排卵组高。结论　PCOS患者的高雄激素、高LH血症、IR、高BMI对促排卵的结局产生负影响。     

Fertility inducing effect of aerial parts of Coccinia cordifolia L. in female rats

Ethnopharmacological relevance

The aerial parts of Coccinia cordifolia L. are used to treat female infertility in West Bengal state of India.

Aim of the study

The present study was undertaken to evaluate the fertility inducing effect of aerial parts of Coccinia cordifolia L. in female rats.

Materials and methods

The effect of aqueous extract of Coccinia cordifolia L. on hyperprolactinemia induced infertility, endometriosis induced infertility and androgen-induced infertility was studied. The effect on serum estrogen level, serum progesterone level and reproductive tract was also evaluated in normal healthy female rats. The extract was administered orally at two different doses of 500 mg/kg and 1000 mg/kg.

Results

In hyperprolactinemia induced infertility model, the numbers of uterine implants were almost 10 times more in the extract treated groups as compared to control. The high dose of extract also produced a significant increase in serum estrogen levels (p < 0.01) and number of corpus luteum (p < 0.05) in healthy female rats. The extract at both doses was effective in reducing the weight of endometrial implants by 70–80%, but failed to induce fertility in rats with endometriosis. The extract was ineffective in inducing fertility in androgen-induced infertility model.

Conclusions

The aqueous extract of Coccinia cordifolia L. induces fertility in hyperprolactinemia induced infertility model in female rats.     

Treatment of hypogonadotropic male hypogonadism: Case-based scenarios

The aim of this study is to review four case-based scenarios regarding the treatment of symptomatic hypogonadism in men. The article is designed as a review of published literature. We conducted a Pub Med literature search for the time period of 1989-2014, concentrating on 26 studies investigating the efficacy of various therapeutic options on semen analysis, pregnancy outcomes, time to recovery of spermatogenesis, as well as serum and intratesticular testosterone levels. Our results demonstrated that exogenous testosterone suppresses intratesticular testosterone production, which is an absolute prerequisite for normal spermatogenesis. Cessation of exogenous testosterone should be recommended for men desiring to maintain their fertility. Therapies that protect the testis involve human chorionic gonadotropin(h CG) therapy or selective estrogen receptor modulators(SERMs), but may also include low dose h CG with exogenous testosterone. Off-label use of SERMs, such as clomiphene citrate, are effective for maintaining testosterone production long-term and offer the convenience of representing a safe, oral therapy. At present, routine use of aromatase inhibitors is not recommended based on a lack of longterm data. We concluded that exogenous testosterone supplementation decreases sperm production. It was determined that clomiphene citrate is a safe and effective therapy for men who desire to maintain fertility. Although less frequently used in the general population, h CG therapy with or without testosterone supplementation represents an alternative treatment.     

IVF周期中克罗米芬促排卵的临床效益分析

目的探索在玻璃化冷冻技术基础上IVF周期中克罗米芬促排卵方案的临床效果及经济效益分析。方法 2006年度101个病例在知情同意下随机分为两组,CC组为国产克罗米芬、HMG并辅以GnRH拮抗剂预防LH峰的促排卵方案;GnRHa组为以常规的GnRHa降调和果纳芬、辅以少量国产HMG的促排卵方案为主;所获胚胎根据子宫内膜条件实施鲜胚移植或玻璃化冷冻复苏后移植,每个病例追踪到孩子出生或所有胚胎用完或本人放弃为止;分析两组得卵数、受精率、2PN率、卵裂率、优良胚胎率、取卵周期活婴分娩率、促排卵药费、周期平均总费用以及每获得一次活婴分娩的平均费用等参数。结果 CC和GnRHa组平均得卵数分别为7.46±4.04和10.19±3.95枚,有极显著性差异;IVF/ICSI受精率分别为85.1%/88.3%和68.3%/76.0%,有极显著性差异;促排卵药费、周期平均总费用以及每获得一次活婴分娩的平均费用分别为1779.65±1123.59元、11008.81±2987.36元、27447.67±7164.10元和9241.62±2883.20元、19393.87±3297.55元、48946.43±8322.38元,组间有极显著性差异,差异因素来源于促排卵药费;2PN率、卵裂率、优良胚胎率、冻胚移植胚胎植入率、取卵周期活婴分娩率分别为84%、97.4%、85.4%、29.1%、37.5%和79%、96.5%、83.3%、34.7%、39.6%,两组间无显著性差异;两组均无熟前LH峰和严重并发症发生事件。结论 IVF中使用克罗米芬联合HMG和GnRH拮抗剂促排卵,结合胚胎玻璃化冷冻技术是一种安全、高效和经济的治疗策略。     

来曲唑与克氯米芬用于多囊卵巢综合征促排卵疗效比较

目的探讨来曲唑与克氯米芬用于多囊卵巢综合征（PCOS）引起无排卵性不孕妇女的促排卵效果及其对生殖激素的影响。方法选择PCOS患者41例,随机分为2组,来曲唑组（试验组）在月经周期第3～7 d口服来曲唑（LE）2.5 mg/d,克氯米芬组（对照组）在月经周期第3～7 d口服克氯米芬50 mg/d,开始超声监测卵泡发育,当最大卵泡平均直径≥18 mm时,肌肉注射绒毛膜促性腺激素（hCG）10 000 IU诱发排卵,于hCG日取肘静脉血测定黄体生成素（LH）、雌二醇（E2）、睾酮（T）,并观察排卵率、妊娠率、子宫内膜厚度及生殖激素的变化。结果来曲唑组的排卵率和周期妊娠率与克氯米芬组相似（P〉0.05）,来曲唑组单个优势卵泡的发生率和在hCG日子宫内膜的厚度均高于克氯米芬组（P〈0.05）,来曲唑组在hCG日血清LH、T水平与克氯米芬组间差异无统计学意义。结论来曲唑用于多囊卵巢综合征引起无排卵性不孕妇女具有良好的排卵率和妊娠率。     

Prognostic factors for ovulatory response with clomiphene citrate in polycystic ovary syndrome

OBJECTIVE: To evaluate prospectively the prognostic factors for ovulatory responses following clomiphene citrate (CC) administration in polycystic ovary syndrome (PCOS). STUDY DESIGN: Fifty-nine infertile patients with a diagnosis of PCOS were recruited. Ovulation was induced using 100 mg/day CC administered daily from days 5 to 9 of the cycle. Endocrine and metabolic parameters between responder and non-responder groups were analyzed. RESULTS: For a 75-g fasting glucose load (75-g OGTT), blood glucose levels at 60 and 120 min, the area under the curve (AUC) and blood insulin levels at 120 min in the non-responder group (n=25) were significantly higher than those in the responder group (n=34), although the measurements of fasting blood glucose and insulin were not significantly different between the two groups. In the receiver operating characteristic curves, the most appropriate cutoff point was 120 mg/dl for the blood glucose level at 120 min and 9000 for the blood glucose x insulin level at 120 min. There were no significant differences in the clinical characteristics or in the endocrine and metabolic parameters between conceived (n=9) and non-conceived groups (n=21). CONCLUSION: The levels of blood glucose and blood glucose x insulin at 120 min after 75-g OGTT could be good biochemical markers of CC resistance in PCOS. No predictors of conception following CC therapy were identified by this study.     

针药结合促排卵的疗效观察

目的:观察针药结合治疗排卵障碍性不孕症的疗效.方法:将36例排卵障碍不孕患者随机分为两组,对照组19例于月经第5天口服克罗米酚50 mg,每日1次,连服5天.共观察50个月经周期.观察组17例,在对照组基础上配合针刺治疗.共观察45个月经周期.观察并记录两组患者卵泡发育及排卵情况、子宫内膜厚度、子宫颈部黏液改变情况及盆腔积液情况.结果:观察组排卵率及妊娠率明显高于对照组,观察组无黄素化未破裂卵泡综合征(Luteinized Unruptured Follicle Syndrome,LUFS)发生,且子宫内膜厚度增加.结论:针刺联合克罗米酚促排卵的排卵率、受孕率均高于单纯口服克罗米酚.