卵泡期地塞米松应用对克罗米芬抵抗的多囊卵巢综合征促排卵作用研究

目的:探讨克罗米芬(CC)联合地塞米松(DEX)对CC抵抗的多囊卵巢综合征(PCOS)患者的促排卵效果。方法:将50名CC抵抗患者随机分为治疗组(A组)和对照组(B组)。A组患者在月经第3￣7日口服CC100mg/d,同时在月经周期的第3￣12日口服DEX1.0mg/d;B组CC的应用同A组,同时在月经周期的第3￣12日口服叶酸片0.5mg/d。月经第8日开始监测卵泡发育情况。当有1个卵泡直径≥18mm或2个卵泡直径≥17mm时,肌注hCG10000IU,36h后性生活。观察2组注射hCG日成熟卵泡数和子宫内膜厚度、促排卵天数、月经周期第22日孕酮水平、排卵率和妊娠率。结果:A组注射hCG日的成熟卵泡数、子宫内膜厚度、月经第22日血清中孕酮水平以及排卵率和妊娠率与B组相比差异均有显著性(P<0.05￣P<0.01);促排卵天数组间无统计学差异(P>0.05)。结论:对CC抵抗的PCOS患者,DEX可以促进排卵,改善CC对子宫内膜的抗雌激素效应,增加子宫内膜厚度,提高排卵率和妊娠率。

Dexamethazone Therapy on PCOS with Clomiphene Resistance during the Follicular Phase

Objective:To evaluate the efficacy of adding dexamethazone(DEX)to clomiphene citrate(CC)in induction of ovulation in polycystic ovary syndrome(PCOS)with CC-resistance.Methods:Total 50 infertile women with CC-resistant PCOS were randomly assigned into 2 groups.Group A:clomiphene citrate 100 mg/d was given from day 3 to day 7 of the cycle and DEX 1.0 mg/d from day 3 to day 12 of the cycle.Group B:same protocol of CC combined with placebo(folic acid tablets)was given from day 3 to day 12 of the cycle.Transvaginal ultrasound examination was done from the next day after the end of CC and according to the follicular size afterwards.hCG(10 000 IU)was given intramuscularly when at least one follicle measured ≥18 mm or two mature follicles measured ≥17 mm.Timed intercourse was advised 36 h after hCG injection.The patients were assessed for signs of ovulation by transvaginal ultrasound 48 h after giving hCG.Serum progesterone were tested on day 22 of the cycle.Results:The mean number of follicles≥18 mm at the time of hCG administration and the mean endometrial thinckness as well as progesterone on day 22 of the cycle were significantly higher in group A than in group B(P< 0.05).Similarly,there were significantly higher rates of ovulation(68% vs 16%)(P<0.01)and pregnancy(32% vs 4%)(P<0.05)in group A.Conclusion:Induction of ovulation by adding DEX to CC in CC-resistant PCOS is associated with no adverse anti-estrogenic effect on the endometrium and higher ovulation and pregnancy rates in a significant number of patients.