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目的:探讨多囊卵巢综合征患者应用达英-35治疗后来曲唑(LE)促排卵的临床疗效。方法:选择研究对象40例,分为LE组20例和氯米芬(CC)组20例,LE组于月经周期第5～9天口服来曲唑5mg/d,CC组月经周期第5～9天口服氯米芬100mg/d。于月经周期第10天开始阴道超声监测卵泡发育,根据卵泡生长速度缓慢酌情给予HMG。当最大卵泡的平均直径≥18mm时,肌内注射人绒毛膜促性腺激素(HCG)6000U诱发排卵,排卵后口服黄体酮胶丸200mg/d。阴道B超监测记录卵泡发育大小、数量和子宫内膜厚度,于HCG日取静脉血测雌二醇(E2)、孕酮(P)水平以及排卵后第7天取静脉血测E2、P水平。观察子宫内膜厚度、妊娠率、流产率及生殖激素水平变化。每例患者观察1～3个周期。结果:两组HMG用量、HCG日子宫内膜厚度、HCG日≥14mm的卵泡数、HCG日≥18mm的卵泡数相似。HCG日LE组E2、排卵后+7天E2均低于CC组,但差异无统计学意义;LE组排卵后+7天P高于CC组,差异有统计学意义(P<0.05)。LE组周期妊娠率33.33%高于CC组的31.25%,但差异无统计学意义,LE组无1例流产。结论:多囊卵巢综合征患者应用达英-35治疗后继用来曲唑促排卵HMG辅助,可降低HMG用量,维持良好卵巢黄体功能,提高临床妊娠率,是一种有效、安全、可行的治疗方案。特别适合对CC促排卵反应不良的患者。
Objective: To investigate the clinical effect of letrozole (LE) on ovulation induction in patients with polycystic ovary syndrome after treatment with da-Ying-35. Methods: 40 cases were selected and divided into LE group (20 cases) and clomiphene citrate group (20 cases). LE group received letrozole 5 mg / d on the 5th to 9th day of the menstrual cycle, 9 days oral clomiphene 100mg / d. Vaginal ultrasound monitoring of follicular development begins on day 10 of the menstrual cycle and is given HMG as slowly as possible based on follicular growth. When the average diameter of the largest follicle ≥ 18mm, intramuscular injection of human chorionic gonadotropin (HCG) 6000U induced ovulation, oral administration of progesterone capsules 200mg / d. Vaginal B-monitoring of the size of the follicular development, the number and thickness of the endometrium on the HCG daily venous blood estradiol (E2), progesterone (P) levels and ovulation 7 days after taking venous blood E2, P levels . Observation of endometrial thickness, pregnancy rate, abortion rate and reproductive hormone levels. Each patient observed 1 to 3 cycles. Results: The amount of HMG, the endometrial thickness on HCG day, the number of follicles ≥14mm on HCG day and the number of follicles ≥18mm on HCG day were similar. E2 in HCG-day LE group and E2 in 7th day after ovulation were lower than those in CC group, but the difference was not statistically significant. The level of P in LE group was higher than that in CC group at 7 days after ovulation (P <0.05). The pregnancy rate of the LE group was 33.33% higher than that of the CC group (31.25%), but the difference was not statistically significant. There was no one case of miscarriage in the LE group. Conclusion: Polycystic ovary syndrome patients treated with up to -35 treatment followed by letrozole ovulation HMG auxiliary can reduce the amount of HMG, maintain good ovarian luteal function and improve clinical pregnancy rate, is an effective, safe and feasible treatment Program. Particularly suitable for CC ovulation poor response to patients.