人绝经期促性腺激素联合氯米芬或来曲唑用于多囊卵巢综合征患者促排卵疗效比较

的探讨人绝经期促性腺激素（HMG）＋氯米芬（CC）、HMG和来曲唑（LE）＋HMO对多囊卵巢综合征（PCOS）患者宫腔内供精人工授精的治疗效果。方法将2007年12月-2008年5月期间在我中心就诊的114例PCOS妇女的114个宫腔内人工授精（AID）周期分为3组：CC＋HMG周期组38个周期，HMG周期组38个周期，LE＋HMG周期组38个周期。分析比较3组的年龄、血清T水平、绒毛膜促性腺激素肌肉注射日（HCG日）平均卵泡直径（MFD）≥14mm的卵泡（成熟卵泡）个数、平均卵泡E2水平、子宫内膜厚度、HCG日单优势卵泡发育成熟百分率、HMG用量和周期妊娠率。结果CC＋HMG组、HMG组和LE＋HMG组患者年龄和血清T水平比较，差异无显著性（P〉0．05），CC＋HMG组HCG日成熟卵泡个数为（2．9±1．6）个，明显多于其他两组HMG组为（1．6±1．0）个，LE＋HMG组为（1．9±1．2）个]，差异有显著性（P〈0．05），而内膜厚度较其他两组薄，差异有显著性（P〈0．05），HMG组与LE＋HMG组HCG日成熟卵泡个数和子宫内膜厚度比较，差异无显著性（P〉0．05）。3组HCG日单优势卵泡发育成熟百分率分别21．05％、78．95％和52．63％，差异有显著性（P〈0．05）。CC＋HMG组、HMG组和LE＋HMG组HMG用量分别为（4．89±1．59）支和（9．88±4．59）支、（9．68±4．67）支（75IU／支），CC＋HMG组与后两组比较，差异有显著性（P=0．00）。HMG组、LE＋HMG组HMG用量比较，差异无显著性（P〉0．05）。3组的周期妊娠率分别为36．84％、39．48％和31．57％，差异无显著性（P〉0．05）。结论HMG促排卵周期更易得到单优势卵泡发育成熟；CC＋HMG促排卵HMG用药量最少；CC＋HMG、HMG和LE＋HMG均可获得满意的周期妊娠率。

Comparison of clinical effects among clompiphene citrate, human menopausal gonadotropin and letrozole in ovulation induction in women with polycystic ovary syndrome

Objective To compare the clinical outcomes of clomiphene citrate （CC） ＋human menopausal gonadotropin （HMG）, HMG, letrozole （LE） ＋HMG for ovulation induction among women with polycystic ovary syndrome （PCOS） undergoing intrauterine insemination （IUI） cycles with frozen donor sperm. Methods A total of 114 infertile women （114 cycles） with PCOS from December 2007 to May 2008 were randomly treated with CC＋ HMG （n=38）, HMG （n=38） and LE＋HMG （n=38）. The number of follicles, serum T, serum estradiol, endometrial thickness, mono mature follicle rates per cycle, dose of HMG used per cycle and pregnancy rates per cycle were compared among the three groups. Results The mean age and T among groups were similar. The total number of mature follicles was significantly greater in the clomiphene citrate group than that in HMG group and LE＋ HMG group （2.9±1.6 vs. 1.6±1.0 or 1.9±1.2, P〈0.05）. Endometrial thickness at the time of HCG administration was significantly thinner in the CC＋ HMG group than the other two. No significant differences were found in the total number of mature follicles and endometrial thickness between HMG and LE＋HMG cycles. No significant differences were found in serum estradiol among three groups. Significant differences were found in mono mature follicle rates per cycle among the three groups （21.05%, 78.95% and 52.63%, P〈0.05）. The dosage of HMG used per cycle among three groups was 4.89±1.59, 9.88±4.59 and 9.68±4. 67 ampules （75 IU/ampule）. Significant differences were found between CC＋ HMG group and HMG group or LE＋ HMG group （P= 0.00）. No significant differences were found between HMG group and LE＋ HMG group. No significant differences were found in clinical pregnancy rates among three groups （36.84%, 39.48% and 31.57%, P〉0.05）. Conclusions Administration of HMG is helpful to obtain mono mature follicle in ovulation induction. The minimal dosage of HMG is required in combination of CC and HMG. Three different protoco