来曲唑联合尿促性素用于排卵障碍患者促排卵效果观察

目的:比较来曲唑(LE)联合尿促性素(HMG)与他莫昔芬(TMX)联合HMG对排卵障碍患者的促排卵效果及其对生殖激素的影响。方法:拟行促排卵治疗的197例排卵障碍不孕症患者随机分实验LE+HMG组(105例、211周期)和对照TMX+HMG组(92例、201周期),实验组于月经周期第3～7天口服LE 5.0 mg/d共5天,第8天起肌注HMG 75～150U/d至HCG日;对照组于月经周期第5～9天口服TMX 10 mg,2次/d共5天,第10天起肌注HMG 75～150 U/d至HCG日。超声监测卵泡发育,并于月经周期第8天和HCG注射日取静脉血测定黄体生成素(LH)、雌二醇(E2)、睾酮(T);观察优势卵泡数、成熟卵泡数、排卵率、妊娠率、子宫内膜厚度、多胎妊娠率、卵巢过度刺激综合征(OHSS)发生率及生殖激素变化。结果:LE+HMG组的排卵率和周期妊娠率与TMX+HMG组相似(P>0.05),HCG日其优势卵泡数和成熟卵泡数均显著低于TMX+HMG组(P<0.05)。两组在HCG日子宫内膜的厚度无明显差异(P>0.05),其在月经周期第8天和HCG日的血清E2水平均显著低于TMX+HMG组(P<0.05),血清T水平及LH水平两组无明显差异(P>0.05)。LE+HMG组未发生1例OHSS及多胎妊娠。结论:LE+HMG用于排卵障碍的不孕症妇女具有良好的排卵率和周期妊娠率,且并发症低。

Observation on the promoting effect of ovulation of letrozole combined with human menopausal gonadotropin for the patients with ovulatory disorder

Objective:To compare the promoting effects of ovulation of letrozole combined with human menopausal gonadotropin(HMG) and tamoxifen combined with HMG for the patients with ovulatory disorder and the effect on reproductive hormones. Methods:A total of 197 infertile patients with ovulatory disorder who were going to receive ovulation induction were randomly divided into experimental group(letrozole combined with HMG,105 patients,211 cycles) and control group(tamoxifen combined with HMG,92 patients,201 cycles),the patients in experimental group were treated with oral administration of letrozole(5.0 mg per day) for five days from the third to the seventh day during menstrual cycle,from the eighth day,they were treated with intramuscular injection of HMG(75～150 U/d) until the day of human chorionic gonadotropin(HCG) injection.The patients in control group were treated with oral administration of tamoxifen(10 mg per time,twice a day) from the fifth day to the ninth day during menstrual cycle for five days,from the tenth day,they were treated with intramuscular injection of HMG(75～150 U/d) until the day of HCG injection.Ultrasound was used to monitor follicular development,and the venous blood samples were obtained on the eighth day during menstrual cycle and the day of HCG injection to detect the levels of luteinizing hormone(LH),estradiol,and testosterone;the numbers of dominant follicles,the numbers of mature follicles,the ovulation rates,the pregnancy rates,the thicknesses of endometrium,the rates of multiple pregnancy,the incidences of ovarian hyperstimulation syndrome(OHSS),and the changes of reproductive hormones in the two groups were observed. Results:There was no statistically significant difference in the ovulation rate and cycle pregnancy rate between the two groups(P>0.05),the numbers of dominant follicles and mature follicles on the day of HCG injection in experimental group were significantly lower than those in control group(P<0.05).There was no statistically significant difference in the thickness of endometrium on the day of HCG injection between the two groups(P>0.05),the levels of serum estradiol on the eighth day during menstrual cycle and the day of HCG injection in experimental group were significantly lower than those in control group(P<0.05).There was no statistically significant difference in the levels of serum testosterone and LH between the two groups(P>0.05).No OHSS and multiple pregnancy occurred in experimental group. Conclusion:Letrozole combined with HMG had high ovulation rate and cycle pregnancy rate for the infertile women with ovulatory disorder,and the incidences of complications were low.