来曲唑对多囊卵巢综合征促排卵的临床应用

目的 探讨来曲唑用于多囊卵巢综合征不孕症妇女促排卵对子宫内膜生长的影响.方法 将患多囊卵巢综合征导致不孕的60例患者,分为来曲唑组40例和克罗米芬组20例.来曲唑组从月经周期第5～9天每日口服来曲唑5mg,克罗米芬组于月经周期第5～9天每日口服克罗米芬50mg.超声监测卵泡发育及子宫内膜厚度,并于月经周期第5天、第10天和注射人绒毛膜促性腺激素日取静脉血测定雌二醇.当最大卵泡的平均直径≥18mm时,肌注人绒毛膜促性腺激素10 000U诱发排卵.观察血雌二醇水平及子宫内膜厚度的变化.结果 来曲唑组在月经周期第10天和注射人绒毛膜促性腺激素日血清雌二醇水平均显著低于克罗米芬组(t值分别为-15.6500、-15.0039,均P<0.05),来曲唑组在月经周期第10天血清雌二醇水平较第5天时下降.两组月经周期第10天子宫内膜厚度经比较无显著性差异,注射人绒毛膜促性腺激素日来曲唑组子宫内膜厚度(8.06±2.13mm)明显厚于克罗米芬组(6.43±1.18mm,t=3.1903,P=0.002).结论 来曲唑用于多囊卵巢综合征不孕症妇女促排卵时,有降低雌激素和抑制子宫内膜生长的作用,但抑制子宫内膜生长作用影响程度小于克罗米芬.

Clinical application of letrozole in ovulation induction for women with polycystic ovary syndrome

Objective To investigate influences of letrozole on endometrial growth of infertile women with polycystic ovary syndrome (PCOS) in ovulation induction. Methods 60 infertile women with PCOS were divided into letrozole group(n=40) and clomiphene citrate (CC) group(n=20). 40 patients in letrozole group received 5mg per day of letrozole and 20 patients in CC group received 50mg per day of CC from day 5 to day 9 of menstrual cycle respectively. Ultrasonography was used to monitor follicular development and endometrial thickness of patients in the two groups. And serum level of estradiol (E2) of all patients was detected on day 5 and day 10 of menstrual cycle and hCG injection day. When diameter of the largest follicle was ≥18mm, the patient was given 10000 U of hCG intramuscularly to induce ovulation. The serum level of E2 and endometrial thickness of all patients in the two groups were compared. Results The level of E2 of patients in the letrozole group was significantly lower than CC group on day 10 of menstrual cycle and hCG injection day respectively (t=-15.6500, -15.0039 respectively,both P<0.05). Furthermore, in the letrozole group, the serum level of E2 on 10 day of menstrual cycle of the patients was lower than that on day 5 of menstrual cycle. In endometrial thickness of patients on day 10 of menstrual cycle there was no significant difference between the two groups, but the endometria of patients in the letrozole group (8.06±2.13mm) were significantly thicker than CC group (6.43±1.18mm) on the hCG injection day(t=3.1903,P=0.002). Conclusion Letrozole could decrease serum level of E2 and inhibit growth of endometrium of infertile women with PCOS in ovulation induction, however, its inhibitory role for endometrial growth is weaker than CC.