来曲唑和克罗米芬用于多囊卵巢综合征促排卵效果的比较

目的比较来曲唑和克罗米芬对多囊卵巢综合征(PCOS)妇女促排卵的效果。方法选择拟促排卵治疗的多囊卵巢综合征患者90例作为研究对象,随机分为3组,每组30例。各组患者均于月经来潮第3天或黄体酮撤药性出血第3天起服药,分别给予克罗米芬50 mg/d、来曲唑2.5或5.0 mg/d口服,连续5 d。月经第10天起行阴道B超监测卵泡生长情况。当优势卵泡≥18 mm时注射人绒毛膜促性腺激素(HCG)10 000 U诱发排卵。结果各组间成熟卵泡数、卵泡成熟所需天数无明显差异(p>0.05);2.5和5.0 mg来曲唑组HCG日子宫内膜比克罗米芬组明显增厚(p<0.05);各组间HCG日血黄体生成素(LH)、雌二醇(E2)和孕酮(P)无明显差异(p>0.05);各组间妊娠率、多胎妊娠率、流产率、OHSS率、LUFS率无明显差异(p>0.05),但2.5和5.0 mg来曲唑组排卵率比克罗米芬组明显增高(p<0.05)。结论 2.5、5.0 mg/d来曲唑用于多囊卵巢综合征患者促排卵,不影响子宫内膜的生长,可获得较高的排卵率,有望成为无排卵性PCOS患者的一线促排卵药。

COMPARISON THE CLINICAL EFFECT OF LETROZOLE AND CLOMIPHENE CITRATE ON OVULATION INDUCTION FOR PATIENTS WITH POLYCYSTIC OVARY SYNDROME

Objective To compare the clinical effect of 2. 5 mg letrozole, 5 mg letrozole and 50 mg clomiphene citrate for ovulation induction in women with polycystic ovary syndrome （PCOS）. Methods A total of 90 patients with PCOS were randomly divided into three groups：2. 5 mg letrozole,5 mg letrozole and 50 mg clomiphene citrate（ n = 30）. Patients were randomized to receive 2. 5 mg letrozole or 5 mg letrozole or 50 mg CC daily for 5 days be- ginning on the 3th day of the menstrual cycle or hemorrahge inducing by withdraw of progesterone. Follicular develop- ment was monitored using transvaginal ultrasound from day 10 onwards. When at least one follicle with a mean diame- ter~〉 18 mm was observed using transvaginal ultrasound, 100 O0 U of human chorionic gonadotrophin were given sub- cutaneously to trigger ovulation. Results Not only the number of mature follicles but also the time of follicles matured did not differ among the three groups. But the endometrial thickness on the day of HCG administration and ovulation were significantly higher in the two letrozole groups than in the CC group. There were no statistically significant differ- ences in the pregnancy rate. Mean serum LH（ and E2 and P） level in three groups was almost similar. Miscarriage rate and OHSS rate and LUFS rate had no significant difference. Conclusion Letrozole had no negative effects in the endometrial thickness. 2.5 mg/d letrozole and 5 mg/d letrozole is associated with a higher ovulation rate than CC in PCOS patients and may have a role as a first -line treatment for anovulatory patients with PCOS.