GnRH-a治疗难治性排卵障碍不孕患者的初步观察

目的探讨常规诱导排卵失败后应用促性腺激素释放激素激动剂(GnRH-a)诱导排卵的临床效果.方法对常规促排卵治疗(氯米芬和HMG)失败的13例排卵障碍不孕患者,其中多囊卵巢综合症(PCOS)5例,小卵泡排卵8例.采用GnRH-a+HMG治疗,并于周期第8天开始B超监测卵泡发育并测定尿LH,当卵泡平均径线达18 mm或尿LH(+)时,给HCG诱发排卵.结果13例患者采用GnRH-a+HMG治疗19个周期,均有优势卵泡发育,其中16个周期(84.2%)卵泡平均径线达18 mm时尿LH仍为(-),给HCG诱发排卵;3个周期提前出现LH峰,取消使用HCG.36.8%的周期为单卵泡发育,75.0%为＜3个优势卵泡,8.3%为4～10个,18.8%为＞10个.妊娠率58.3%,周期妊娠率41.2%,其中单胎4例,双胎2例,4胎1例;自然流产的发生率为14.3%.结论GnRH-a可增强PCOS患者对HMG的反应性,防止内源性LH峰早现,并有良好的妊娠率及妊娠结局,可望作为治疗PCOS及小卵泡排卵患者的二线药物;低剂量HMG可使75%的治疗周期中卵泡发育数＜3个.

The effectiveness of gonadotrophin releasing hormone agonist on infertile patients with ovulation disorder and poor response

Objective To study the effectiveness of goriadotrophin releasing hormone agonist (CnRH - a) on patients with ovulation disorder and poor response to clomiphene citrate (CC) or human menopausal gonadotropin (HMG) . Methods 13 cases with ovulation disorder and poor response to CC or HMG were enrolled, including 5 cases of polycystic ovary syndrome (PCOS) and 8 cases of small follicle ovulation. All cases were treated with GnRH - a + HMG. Transvaginal ultrasonography was taken to monitor the growth of follicle on the day 8th of the cycle. When the average diameter of dominant follicle arrived 15 mm urine LH assay was tested every day. When the average diameter arrived 18 mm or urine LH ( + ), HCG was given to induce ovulation. Results Dominant follicles developed in all 19 treatment cycles of GnRH - a + HMG. Average diameter of the dominant follicle arrived 18mm and urine LH were still negative in 16 cycles (84.2% ), premature luteinization happened in other 3 cycles so HCG was stopped because of small follicle. Monofollicle growth happened in 36.8% cycles, less than 3 dominant follicles in 75% cycles, 4 to 10 in 8.3% cycles, more than 10 in 18.8% cycles. Pregnancy rates was 58.3% , while pregnancy rate per cycle was 41.2%. 4 cases were singletons, 2 cases twins and 1 case quadruplets. Miscarriage rate was 14.3% . Conclusions GnRH - a could enhance the ovarian response to HMG in patients with PCOS and prevent premature luteinizan'on, facilitate follicu-lar development and give higher pregnancy rate and satisfactory pregnancy outcome. GnRH - a may be an efficient therapy in patients with PCOS and small follicular ovulation poor response to CC or HMG. After low doses HMG less than 3 follicles will be found in 75% cycles.