来曲唑和克罗米酚对PCOS的促排卵及妊娠结局的比较研究

目的:比较来曲唑和克罗米酚对PCOS的促排卵及妊娠结局,旨在寻找一种新的促排卵药物。方法:拟行促排卵治疗的多囊卵巢综合征(PCOS)患者66例,分为来曲唑组20例和克罗米酚组46例。来曲唑组(LE)从月经第3～7天给与LE5.0mg/d口服,第7天加用尿促性腺激素(HMG)至HCG日;克罗米酚组(CC)从第5～9天给与CC100mg/d口服,第6天加用HMG至HCG日。于HCG日观察≥14mm卵泡数、≥16mm卵泡数、子宫内膜厚度、形态和血清E2、LH、T水平以及排卵后第7天血清E2、P水平。记录妊娠率、流产例数、异位妊娠例数和OHSS发生例数。结果:尽管HCG日LE组E2水平显著性的低于CC组(P(0.01),但是子宫内膜的厚度和形态两组无差异。然而CC组中有13例患者HCG日子宫内膜厚度(7.0mm,LE组中无1例。与CC组相比,HCG日LE组≥14mm数明显减少(P(0.05),且无1例卵巢过度刺激综合征(OHSS)的发生。LE组妊娠率和继续妊娠率都高于CC组,但无统计学意义。结论:LE有类似CC的促排卵作用及相似的妊娠率。

A comparison of the effects and pregnancy outcome of letrozole versus clomiphene citrate for ovulation induction in women with polycystic ovarian syndrome

Objective:To search for a new drug for ovulation induction through a comparison of the effects and pregnancy outcome of letrozole(LE)versus clomiphene citrate(CC)for induction of ovulation.Methods:The patients with polycystic ovarian syndrome(PCOS)undergoing ovarian stimulation were divided into LE group and CC group.All subjects received either LE at a dosage of 5.0mg daily from cycle day 3 to 7 plus HMG injection staring on day 7 or CC(100mg/day)from day 5 to day 9 plus HMG injection on day 6 until the day of HCG.The number of follicle ≥14 mm and follicle ≥16 mm,endometrial thickenss and pattern were observed on the day of HCG.Some samples were analyzed including serum E2,testosterone and LH on the day of HCG and E2 and P on day +7 after follicular rupture.Meanwhile,pregnancy rate were recorded as well as the case of miscarriage,ectopic and ovarian hyperstimulation syndrome(OHSS).Results:Despite there being significantly(P<0.01)lower E2 level in the letrozole group,no significant differences between two groups were found in terms of endometrial thickenss and endometrial pattern on the day of HCG.However,endometrial thickenss was thinner 7 mm in 13 patients from the CC group at the time of HCG administration,without anyone in the LE group.Compared with the CC group,letrozole was associated with a statistically significantly fewer follicles ≥14 mm and no one patient with OHSS.The pregnancy rate and ongoing pregnancy rate were higher in the LE group,but a marked difference wasn't found between the two groups.Conclusion:Letrozole results in stimulation of ovarian folliculogenesis and the pregnancy rate similar to that seen with CC.