耐氯米芬多囊卵巢综合征患者不孕症的治疗

目的:探讨耐氯米芬(CC)的多囊卵巢综合征(PCOS)不孕患者的治疗方法和疗效.方法:选择CC抵抗的PCOS伴不孕的患者46例共69个治疗周期,分为4组:①复方CPA CC组,12例,18个周期.②复方CPA 高纯度卵泡刺激素(FSH-HP)组,11例,20个周期.③二甲双胍 CC组,12例,16个周期.④二甲双胍 FSH组,11例,15个周期.1、2组先给予复方CPA治疗2～4个月,3、4组先行二甲双胍治疗2个月.然后比较各个组促排卵后的妊娠率、流产率、卵巢过度刺激综合征(OHSS)和多胎发生等情况.结果:1～4组的周期排卵率分别为77.8%、90.0%、81.3%及93.3%;妊娠率分别为16.7%、30.0%、18.8%及33.3%;仅第1组有1例流产,第2组有1例双胎,第4组有1例发生中度OHSS.2、4组的排卵率和妊娠率高于其余两组,但差异无显著性,而流产率、多胎率和OHSS发生率也无明显差异.结论:对氯米芬抵抗的不孕患者,宜先行前期治疗纠正内分泌紊乱,再用CC或FSH低剂量开始促排卵,可改善促排卵的反应性.

Treatment of infertility in women with Clomiphene-resistant polycystic ovary syndrome

Objective: To study the methods and effects of treatment in women with clomiphene(CC)-resistant polycystic ovary syndrome(PCOS). Methods: Forty six patients with CC-resistant PCOS were studied.They were divided into four groups with 69 treatment cycles, including Diane-35 plus CC(12 cases,18 cycles,group 1),Diane-35 plus FSH(11 cases,20 cycles,group 2),Metformin plus CC(12 cases,16 cycles,group 3)and Metformin plus FSH(11 cases,15 cycles,group 4).The rates of pregnancy and abortion, occurrence rates of ovarian hyperstimulation syndrome(OHSS) and multipregnancy were analysed. Results: The ovulation rates and pregnancy rates per cycle of the four groups were 77.8%,90%,81.3% and 93.3%, 16.7%,30%,18.8% and 33.3%, respectively.No correlation was found between ovulation rates and pregnancy rates in the four groups, although the group 2 and 4 had higher ovulation rate and pregnancy rate than the group 1 and 3.One cases aborted in group 1, and two cases had twins in group 2, another patient developed medium OHSS in group 4.There were no statistical significance among these groups. Conclusions: Before ovarian stimulation with low dosage CC or FSH in infertility women with CC-resistant cases,it is suitable to use pretreatment,which can reverse the endocrine abnormalities,and may improve the ovarian response.