来曲唑联合促性腺激素用于行宫腔内人工授精的排卵障碍者的促排卵研究

目的:探讨来曲唑在促排卵过程中的功效。方法:100例不孕症常规检查确诊为女性排卵障碍并接受超促排卵及IUI的不孕患者,随机分为A组(50例):口服来曲唑(LE)+hMG,B组(50例):口服氯米芬(CC)+hMG,分别监测hCG注射日子宫内膜的厚度、形态、血E2、P水平,分别统计排卵率及妊娠率。结果:A组血清中雌激素水平明显较低,hCG注射日子宫内膜较厚。直径>17mm卵泡数组间无明显差异,临床妊娠率也无明显差异。结论:对因女性排卵障碍引起的不孕,用LE或CC促排卵,其获卵数和临床妊娠率无差异,但用LE促排卵,可以减少CC抗雌激素样作用对子宫内膜的不良影响,使子宫内膜有较好的容受性,有利于妊娠。     

氯米芬和来曲唑在多囊卵巢综合征不孕患者微刺激促排卵中的应用比较

目的:探讨氯米芬(CC)和来曲唑(LE)在多囊卵巢综合征(PCOS)不孕患者微刺激促排卵中的作用。方法:选择2011年10月至2014年2月在北京大学深圳医院治疗的230例PCOS不育患者,于月经第3~5天应用CC(CC组82例)或LE(LE组148例)。CC组每日50mg,连服5日;LE组随机分两组,一组(85例)每日2.5 mg,连服7日,另一组(63例)每日5.0mg,连服5日。月经第10日开始定期经阴道超声监测各组子宫内膜和卵泡。对各组获得平均直径≥18 mm卵泡数、诱发排卵日子宫内膜厚度和每个平均直径≥18 mm卵泡产生的E2量、周期妊娠率等进行统计比较。结果:1230例PCOS患者促排卵230个周期,CC组促排卵82个周期;LE 2.5 mg组促排卵85个周期;LE 5.0 mg组促排卵63个周期。CC组、LE 2.5 mg组及LE5.0 mg组周期妊娠率分别为7.3%、20.0%、31.7%,3组周期妊娠率比较,CC组与LE 2.5 mg组及LE 5.0 mg组差异均有统计学意义(P0.05)。2CC组、LE 2.5 mg组及LE 5.0 mg组促排卵应用HMG率分别为26.8%、43.5%、44.4%。CC组与LE 2.5 mg组及LE 5.0 mg组比较,差异均有统计学意义(P0.05);CC组、LE 2.5 mg组及LE 5.0 mg组促排卵应用戊酸雌二醇率分别为72.0%、44.7%、33.3%。CC组与LE 2.5 mg组及LE 5.0 mg组比较,差异均有统计学意义(P0.01)。3诱发排卵日子宫内膜厚度CC组较LE 2.5 mg组及LE 5.0 mg组薄,差异有统计学意义(P0.01)。诱发排卵日E2量CC组大于LE 2.5 mg组及LE 5.0 mg组,差异有统计学意义(P0.01)。结论:PCOS微刺激促排卵应用LE较CC对子宫内膜影响小、周期妊娠率高。     

滋阴补阳序贯法联合西药促排卵对PCOS患者的临床疗效分析

目的:探讨滋阴补阳序贯法联合西药促排卵对PCOS患者的临床疗效。方法:回顾性分析72例多囊卵巢综合征(PCOS)患者122个促排卵周期患者的临床资料,所有患者均于促排卵前后使用滋阴补阳中药进行序贯治疗。根据促排卵方案不同分为4组,A组:克罗米芬(CC)+促性腺激素(Gn)(n=71),B组:来曲唑(LE)+Gn(n=30),C组:CC(n=14),D组:Gn(n=7),比较各组间临床和实验室指标。结果:4组妊娠率比较:C组A组B组D组;Gn用量比较:D组B组A组,hCG注射日子宫内膜厚度:A组D组B组C组,但各指标组间比较均无统计学差异(P0.05),促排天数A组显著高于其它3组(P0.05)。hCG注射日子宫内膜厚度7 mm的比例CC组显著高于其它3组(P0.05)。4组未破裂卵泡黄素化综合征(LUFS)发生率、未启动率均无统计学差异(P0.05),无OHSS发生。按妊娠结局分组比较:bE2及bLH水平妊娠组未孕组,差异有统计学意义(P0.05)。妊娠组子宫内膜厚度显著高于未孕组,各组中A型内膜比例显著高于其它类型内膜。结论:对PCOS患者选择滋阴补阳序贯法联合CC+Gn促排卵能减少Gn用量,降低卵巢过度刺激综合征(OHSS)发生率,增加子宫内膜厚度,改善子宫内膜容受性,提高妊娠率。     

甲磺酸溴隐亭辅助克罗米芬诱导多囊卵巢综合征不孕患者排卵的随机、开放、对照临床研究

目的研究多巴胺激动剂溴隐亭(BCT)联合克罗米芬(CC)对多囊卵巢综合征(PCOS)合并不孕患者促排卵助孕的疗效。方法本研究为随机、开放、对照试验,在上海2家医院共收集PCOS合并不孕患者100例,随机分为对照组和试验组,对照组在月经周期3~7 d给予CC 50 mg/d,试验组在此基础上同时全周期给予BCT 2.5 mg/d,两组均治疗1个周期。在月经第3日、hCG注射日、hCG注射第7日抽血化验激素水平,包括促卵泡激素(FSH)、促黄体生成素(LH)、催乳素(PRL)、雌二醇(E_2)、总睾酮(T)、孕激素(P),并行阴道超声测定子宫内膜厚度、卵泡大小、数量。结果两组的基础激素水平无统计学差异。对照组和试验组的促排卵成功率分别为72.0%和75.4%(P0.05),试验组的持续妊娠率(18.4%)明显高于对照组(8.0%)。hCG注射日的FSH、E_2、P水平无统计学差异,LH水平有所降低,PRL和T显著降低(分别为P=0.00,P=0.00);hCG注射第7日的E_2、P水平无统计学差异,PRL显著下降,试验组的子宫内膜厚度[(10.20±1.92)mm]明显高于对照组[(9.22±1.88)mm](P=0.01)。结论 BCT联合CC可以提高PCOS患者促排卵的助孕成功率,降低PRL、LH、T水平并增加着床窗口期的子宫内膜厚度。提示多巴胺激动剂BCT可能通过降低垂体激素及雄激素水平、降低子宫内膜血管阻力并增加内膜血供改善PCOS不孕患者的助孕结局。     

来曲唑联合克罗米芬治疗多囊卵巢综合征患者的疗效及对排卵、妊娠情况的影响CSCD

目的 探讨来曲唑(LE)联合克罗米芬(CC)治疗多囊卵巢综合征(PCOS)的临床效果。方法选取2019年3月至2021年2月河北省沧州市中心医院120例PCOS患者为研究对象,其中接受单一CC治疗的60例患者为对照组,而联合组(60例)给予LE+CC治疗方案。比较两组患者的月经情况、性激素水平[黄体生成素(LH)、雌二醇(E2)、孕酮(P)],记录两组患者的排卵、妊娠情况。结果 联合组成熟卵泡个数、子宫内膜厚度、月经周期、月经量、早期流产率均低于对照组(P <0.05)。治疗后,联合组E2、LH、P分泌水平及排卵率、妊娠率、双胎率均高于对照组(P <0.05)。结论 LE联合CC治疗PCOS患者可取得较好的促排卵助孕的疗效。     

来曲唑与克罗米芬对多囊卵巢综合征患者促排卵治疗结局的前瞻性随机对照研究

目的:比较来曲唑和克罗米芬在多囊卵巢综合征(PCOS)患者促排卵治疗中的效果和妊娠结局。方法:选取拟行促排卵治疗的PCOS患者136例,随机分为来曲唑组(LE)68例和克罗米芬组(CC)68例。HCG注射日观察平均直径14～18mm的卵泡数、平均直径≥18mm的卵泡数、子宫内膜厚度和血清E2水平;比较两组HMG用量、排卵率、临床妊娠率、流产率、畸形率及卵巢过度刺激综合征(OHSS)的发生率。结果:LE组HCG注射日平均直径14～18mm卵泡数、E2水平显著低于CC组(P<0.05),子宫内膜厚度及单卵泡排卵率显著高于CC组(P<0.05);LE组HCG日注射日平均直径≥18mm卵泡数略低于CC组,但差异不显著(P>0.05);CC组OHSS发生率为7.4%,LE组无OHSS发生,两组相比差异有统计学意义(P<0.05);LE组临床妊娠率略高于CC组,但差异无统计学意义(P>0.05)。结论:来曲唑用于治疗多囊卵巢综合征引起的无排卵性不孕,单卵泡排卵率和临床妊娠率良好,临床应用前景较好,有可能成为新一代一线促排卵药物。     

单次大剂量雌激素在氯米芬促排卵前的应用

目的:观察氯米芬(CC)促排卵时,排卵前单次应用大剂量雌激素的效果。方法:选择排卵障碍的不孕症患者60例,随机分为研究组和对照组,各30例。所有患者均于月经第5天开始服用CC,100mg/d,共5天。研究组患者在最大卵泡的平均直径≥18～20mm时,单次口服戊酸雌二醇12mg;对照组患者于月经第9天起每日加服戊酸雌二醇2mg,直至最大卵泡的平均直径≥18～20cm。阴道超声监测卵泡发育及子宫内膜厚度,比较两组患者妊娠情况。结果:两组HCG日≥18～20cm的优势卵泡个数差异无统计学意义(P>0.05)。研究组HCG日子宫内膜平均厚度显著低于对照组[(8.0±1.3)mm vs(9.8±1.4)mm,P<0.05],但排卵率显著高于对照组(86.7%vs 63.3%,P<0.05),临床妊娠率亦显著高于对照组(60.0%vs 33.3%,P<0.05)。研究组中1例患者出现卵泡未破黄素综合征,对照组中5例出现卵泡黄素化未破裂,两组比较差异无统计学意义(P>0.05)。两组患者均未出现卵巢过度刺激综合征。结论:氯米芬促排卵时,应用雌激素能够改善子宫内膜,排卵前单次大剂量雌激素应用,更利于排卵及妊娠。     

克罗米芬联合促卵泡素治疗多囊卵巢综合征的疗效观察

目的:比较单用克罗米芬(CC)及其联合不同促卵泡素(FSH)治疗多囊卵巢综合征(PCOS)患者的效果,以指导PCOS患者选择合适的促排卵方案.方法:选取2009年1月至2012年7月就诊于我院生殖门诊的81例PCOS患者(共92周期),患者均以CC促排卵,根据月经第8天的卵泡生长情况,决定是否联合应用基因重组促卵泡素(rFSH)或尿促卵泡素(uFSH).按促排卵方案不同将患者分为3组:CC+ HCG组(A组,26例,32周期);CC+rFSH+HMG+HCG组(B组,23例,26周期);CC+uFSH+HMG+HCG组(C组,32例,34周期).患者排卵后均用黄体酮胶丸或地屈孕酮黄体支持12 ～ 14天.比较3组患者促排卵治疗的效果.结果:A组中2例患者发生黄素化综合征(LUFS);B组中4例发生轻度卵巢过度刺激综合征(OHSS);C组中1例发生重度OHSS,1例LUFS.3组患者的HCG日最大卵泡直径、内膜厚度、排卵率及妊娠率均无显著差异(P＞0.05).A组D8优势卵泡直径大于B、C组(P＜0.05);至HCG日平均时间少于B、C组(P＜0.05);B组直径≥1.5cm卵泡数和排卵数均显著高于A、C组(P＜0.05).B组与C组的至HCG注射日时间和FSH用量均无显著差异(P＞0.05).结论:CC促排周期D8优势卵泡直径大小对决定联合FSH治疗PCOS患者有一定的参考意义.单用CC促排卵可能抵抗周期,联合uFSH是经济有效的促排卵方案.     

温肾活血汤联合克罗米芬改善促排卵子宫内膜容受性疗效研究

目的:探讨温肾活血汤联合克罗米芬(clomiphene citrate,CC)促排卵治疗后对子宫内膜容受性的影响。方法:45例排卵障碍型不孕患者随机分成A组(CC)、B组(CC+阿司匹林)、C组(CC+温肾活血中药),每组15例。治疗1～3个疗程,观察排卵率、妊娠率及hCG注射日子宫内膜类型及厚度。结果:C组A+B型内膜率(91.18%)显著高于A组(76.92%,P<0.01)及B组(66.67%,P<0.05);C组内膜平均厚度(9.4±2.2mm)显著高于A组(7.8±1.4mm),P<0.05。周期排卵率C组(82.35%)>B组(76.92%)>A组(69.23%),但各组间无统计学差异(P>0.05);未破裂卵泡黄素化综合征(LUFS)发生率C组(5.88%)显著低于A组(23.08%)(P<0.05)。周期妊娠率C组(23.5%)>B组(15.4%)>A组(10.3%)(P<0.05)。结论:温肾活血汤能提高克罗米芬促排卵治疗后的妊娠率,其机制可能与促进排卵、降低LUFS发生及改善子宫内膜容受性有关,其改善内膜容受性的效果好于阿司匹林联合CC。     

来曲唑序贯氯米芬在多囊卵巢综合征患者中的应用

目的:探讨来曲唑(LE)序贯氯米芬(CC)对多囊卵巢综合征(PCOS)患者的促排卵效果。方法:分析PCOS患者共62例,72个促排周期。按促排卵方案分为LE序贯尿促性素(HMG)组和LE序贯CC组,比较两组单卵泡率、HCG日子宫内膜厚度、未成熟卵泡率、排卵率、卵泡过度刺激综合征(OHSS)发生率、临床妊娠率、多胎妊娠率及用药时间、费用的差异。结果:LE序贯HMG组和LE序贯CC组的单卵泡率分别为78.95%、88.24%,未成熟卵泡率为7.89%、2.94%,排卵率分别为89.47%、97.06%,OHSS发生率分别为5.26%、0,临床妊娠率分别为13.16%、11.76%,多胎妊娠率分别为5.26%、2.94%,差异均无统计学意义(P0.05),LE序贯HMG组HGC日子宫内膜厚度(10.27±1.92 mm)明显厚于LE序贯CC组(9.13±2.32 mm)(P0.05)。LE序贯CC组用药时间(10.00±0.00天)明显少于LE序贯HMG组(12.16±1.98天)(P0.05)。LE序贯HMG组的费用明显高于LE序贯CC组。结论:LE序贯CC与LE序贯HMG的排卵效果及妊娠率近似,OHSS发生率无明显差别,LE序贯CC用药时间更短,费用更低,但HCG日子宫内膜更薄,应用中应适当补充雌激素促进内膜生长。     

Use of dexamethasone and clomiphene citrate in the treatment of clomiphene citrate-resistant patients with polycystic ovary syndrome and normal dehydroepiandrosterone sulfate levels: a prospective,double-blind,placebo-controlled trial

OBJECTIVE: To evaluate the effects of short-course administration of dexamethasone (DEX) combined with clomiphene citrate (CC) in CC-resistant patients with polycystic ovary syndrome (PCOS) and normal DHEAS levels. DESIGN: Prospective, double-blind, placebo-controlled, randomized study. SETTING: Referral university hospitals. PATIENT(S): Two hundred thirty women with PCOS and normal DHEAS who failed to ovulate after a routine protocol of CC. INTERVENTION(S): The treatment group received 200 mg of CC from day 5 to day 9 and 2 mg of DEX from day 5 to day 14 of the menstrual cycle. The control group received the same protocol of CC combined with placebo. MAIN OUTCOME MEASURE(S): Follicular development, hormonal status, ovulation rate, pregnancy rate. RESULT(S): Mean follicular diameters were 18.4124 +/- 2.4314 mm and 13.8585 +/- 2.0722 mm for the treatment and control groups, respectively. Eighty-eight percent of the treatment group and 20% of the control group had evidence of ovulation. The difference in the cumulative pregnancy rate in the treatment and control groups was statistically significant. CONCLUSION(S): Hormonal levels, follicular development, and cumulative pregnancy rates improved with the addition of DEX to CC in CC-resistant patients with PCOS and normal DHEAS. This regimen is recommended before any gonadotropin therapy or surgical intervention.     

Combined metformin and clomiphene citrate versus highly purified FSH for ovulation induction in clomiphene-resistant PCOS women: a randomised controlled trial

Aim.?To compare the effect of combined metformin–clomiphene citrate (CC) with highly purified urinary FSH (HP-uFSH) for ovulation induction in CC-resistant women with polycystic ovary syndrome (PCOS).

Methods.?One-hundred fifty-three anovulatory women with CC-resistant PCOS were selected in this randomised controlled trial. Patients received combined metformin–CC (n?=?75, 205 cycles) or HP-uFSH (n?=?78, 186 cycles) for three cycles. Outcome measures were; Ovulation rate, number of growing and mature follicles, serum E2, serum P, endometrial thickness, pregnancy and miscarriage rates.

Results.?The ovulation rate per cycle was significantly higher in the HP-uFSH group (83.8% vs. 62%, p?=?0.01). The number of follicles ≥12?mm ≥14?mm and ≥18?mm on the hCG day was significantly greater in the HP-uFSH group (p?=?0.01, p?=?0.02 and p?=?0.03, respectively). Pregnancy occurred in 23/205 cycles (11.2%) in combined metformin–CC group and 40/186 cycles (21.5%) in the HP-uFSH group; the difference was statistically significant (p?=?0.02). Two patients in the HP-uFSH group suffered mild OHSS.

Conclusions.?Combined metformin–CC resulted in modest ovulation and pregnancy rates without side effects. It is logical to offer this first for CC-resistant PCOS women before resorting to more expensive alternatives especially in developing communities where economic aspects of therapy are important.     

A prospective,double-blind,randomized, placebo-controlled clinical trial of bromocriptine in clomiphene-resistant patients with polycystic ovary syndrome and normal prolactin level

OBJECTIVE: To evaluate the effects of administration of bromocriptine combined with clomiphene citrate (CC) in CC-resistant patients with polycystic ovary syndrome (PCOS) and normal prolactin (PRL) level. DESIGN: Prospective double-blind, placebo-controlled, randomized. SETTING: Referral university hospitals. PATIENTS: One hundred women with PCOS and normal PRL who failed to ovulate with a routine protocol of CC. INTERVENTIONS: Treatment group received 150 mg of CC from day 5 to 9 and 7.5 mg bromocriptine continuously, with hCG 10,000 units on day 16 or 17. Control group received the same protocol of CC combined with placebo. MAIN OUTCOME MEASURES: Follicular development, hormonal changes, ovulation rate, pregnancy rate. RESULTS: Follicular development (follicular size greater than 15 mm) was observed in 12 (25.5%) and 8 (15.1%) women in the treatment and placebo group, respectively (p = 0.29). The serum prolactin level was within normal limits in all patients before treatment. After 3 and 6 months of treatment with bromocriptine, there was a significant decrease in serum level of prolactin (p = 0.000001). No significant differences were seen in ovulation, pregnancy rate, or serum levels of FSH, LH, DHEAS, and progesterone between treatment and placebo groups after treatment. CONCLUSIONS: The only significant effect of long-term bromocriptine therapy in CC-resistant women with PCOS was to lower the serum PRL concentration. It is also concluded that 10%-15% of patients with PCOS experienced occasional ovulatory cycles and pregnancy whether or not they were on treatment.     

N-acetylcysteine as an adjuvant to clomiphene citrate for successful induction of ovulation in infertile patients with polycystic ovary syndrome

Aim: The aim of this study was to evaluate the effect of oral N-acetylcysteine (NAC) administration as an adjuvant to clomiphene citrate (CC) on induction of ovulation outcomes in patients with polycystic ovary syndrome (PCOS). Material and Methods: In this placebo-controlled double-blind randomized clinical trial, 180 PCOS infertile patients were randomly divided into two groups for induction of ovulation. Patients in group 1 received CC 100?mg/d plus NAC 1.2?g/d and patients in group 2 received CC plus placebo for 5?days starting at day 3 of the cycle. On the 12th day of the menstrual cycle in the presence of at least one follicle with an 18-20-mm diameter in ultrasound evaluation, 10?000?U hCG was injected intramuscularly and timed intercourse was advised 36?h after hCG injection. Serum β-hCG level was measured on the 16th day after hCG injection. Results: The number of follicles >18?mm and the mean endometrial thickness on the day of hCG administration were significantly higher among the CC+NAC group (P-value?=?0.001). The ovulation and pregnancy rates were also significantly higher in the CC+NAC group (P-value?=?0.02 and 0.04, respectively). No adverse side-effects and no cases of ovarian hyperstimulation syndrome were observed in the group receiving NAC. Conclusion: NAC as a safe and well-tolerated adjuvant to CC for induction of ovulation can improve the ovulation and pregnancy rates in PCOS patients. It may also have some beneficial impacts on endometrial thickness.     

N-acetyl-cysteine is a novel adjuvant to clomiphene citrate in clomiphene citrate-resistant patients with polycystic ovary syndrome

OBJECTIVE: To evaluate the effect of N-acetyl-cysteine (NAC), a mucolytic drug with insulin sensitizing properties, as an adjuvant therapy in subjects with polycystic ovary syndrome (PCOS) resistant to clomiphene citrate (CC). DESIGN: Placebo-controlled, double-blind randomized trial. SETTING: University-based hospital and private infertility practice. PATIENT(S): One hundred fifty women diagnosed with CC-resistant PCOS, aged 18-39 years undergoing therapy for infertility were included. INTERVENTION(S): The patients were assigned randomly to receive either NAC 1.2 g/d (group I) or placebo (group II) with CC 100 mg/d for 5 days starting at day 3 of the cycle. MAIN OUTCOME MEASURE(S): Ovulation rate and pregnancy rate (PR). RESULT(S): Combination of CC and NAC significantly increased both ovulation rate and PR in women with CC-resistant PCOS (49.3% vs. 1.3% and 21.3% vs. 0%, respectively). No cases of ovarian hyperstimulation syndrome (OHSS) were reported in the NAC group; two cases of miscarriage (12.5%) were reported. CONCLUSION(S): The NAC as an adjuvant to CC was more effective than placebo for CC-resistant patients with PCOS. It is safe and well tolerated.     

Sequential clomiphene citrate/hMG versus hMG for ovulation induction in clomiphene citrate-resistant women

Objective

This study was designed to compare sequential clomiphene citrate/hMG regimen to hMG regimen for ovulation induction in clomiphene citrate-resistant women.

Study design

A comparative prospective study.

Patients and methods

Ninety infertile women were randomized to receive either sequential CC/hMG regimen (45 women) or low-dose step-up protocol of hMG (45 women). All participants had received at least six consecutive cycles of clomiphene citrate for ovulation induction within the last year before inclusion in this study, but they did not conceive. The CC/hMG regimen group received clomiphene citrate 100 mg/day for 5 days, followed by hMG 75 IU for 4 days. The hMG group received low-dose step-up protocol for 10–14 days. To detect the number and size of the follicles, TVS was done on cycle day 8 and repeated daily or every other day according to follicular development. When one to three follicles reached a diameter ≥18 mm, hCG injection was scheduled. Before hCG injection, the E2 level and endometrial thickness were evaluated. β-hCG levels were measured on cycle day 22.

Results

There was no significant difference between the two studied groups regarding the demographic data, sperm parameters, and day 3 FSH, LH and estradiol. Also, there was no significant difference between the two studied groups regarding endometrial thickness, number of mature follicles, peak of E2 before hCG injection and number of cases that developed ovarian cyst or OHSS. The dose of gonadotropins used was significantly low in the CC/hMG group compared to the hMG group (295.2 ± 75.5 vs. 625.3 ± 65.0, respectively), and the pregnancy rate was significantly high in the CC/hMG group compared to the hMG group [12 (26.7 %) vs. 3 (6.7 %), respectively, p < 0.05].

Conclusion

The sequential CC/hMG regimen is as effective as hMG regimen for ovulation induction, produces satisfactory pregnancy results and reduces the treatment cost.     

Clomiphene Citrate co-treatment with low dose urinary FSH versus urinary FSH for clomiphene resistant PCOS: randomized controlled trial

Purpose

The aim of this study was to examine the effect of clomiphene citrate [CC] co-administration during the use of exogenous low-dose urinary FSH [uFSH] for induction of ovulation in CC-resistant infertile PCOS women.

Methods

In a randomised controlled setting, 174 CC-resistant infertile PCOS women were randomized into two parallel groups; Group I received CC 100 mg/day for 5 days plus uFSH 37.5 IU/day while group II received only uFSH 37.5 IU /day. Subsequent increments of uFSH by 37.5 IU/day were made according to response. Primary outcome was ovulation rate. Secondary outcomes were clinical pregnancy rates, number of follicles, endometrial thickness, and gonadotropins consumption.

Results

Our results have demonstrated that group I compared to group II had significantly higher ovulation rate per intention to treat [ITT] [72.4 % vs. 34.2 %, p < 0.001]. Clinical pregnancy and live birth rates were comparable between the two groups. Group I consumed significantly lower total FSH dose and needed significantly shorter stimulation duration compared to group II.

Conclusion

CC co-administered during low dose HP uFSH versus uFSH for CC-resistant PCOS yields significantly higher ovulation rate and less consumption of FSH.     

A randomized comparison of ovulation induction and hormone profile between the aromatase inhibitor anastrozole and clomiphene citrate in women with infertility.

BACKGROUND: IN the present study we evaluated and compared the effects of ovulation and hormonal dynamics induced by anastrozole and clomiphene citrate in women with infertility. MATERIALS AND METHODS: Thirty-three infertile patients, aged 25-41 years, were enrolled. Patients received either anastrozole 1 mg daily (AI group) or clomiphene citrate 100 mg daily (CC group) from cycle day 3 to day 7. Number of mature follicles (> or =18 mm), endometrial thickness, pregnancy rate and serial hormone profiles (follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E(2)), testosterone and progesterone) were measured on cycle day 3, day 8, day 10, the day of intrauterine insemination (IUI), day 7 after IUI and day 14 after IUI. RESULTS: Baseline parameters were similar in the two groups, including age, body mass index, infertility duration and day-3 serum hormones except FSH. The mean FSH value on day 3 was significantly different (4.3 mIU/ml in the AI group vs. 6.3 mIU/ml in the CC group; p < 0.05). The women receiving anastrozole had fewer ovulatory follicles (1.2 in the AI group vs. 1.8 in the CC group; p < 0.05) and a thicker endometrium (10.6 mm in the AI group vs. 7.8 mm in the CC group; p < 0.05). The levels of progesterone and testosterone were similar during ovulation stimulation cycles in both groups. On the other hand, the AI group had a significantly higher LH level but a significantly lower E(2) level in the stimulation cycle. CONCLUSION: Anastrozole has a high pregnancy rate, although it induces fewer ovulatory follicles compared with clomiphene citrate. The two drugs gave different responses of FSH, LH and E2 during stimulation cycles.     

Review of nonsurgical and surgical treatment and the role of insulin-sensitizing agents in the management of infertile women with polycystic ovary syndrome

OBJECTIVES: To review the nonsurgical and surgical treatment and the role of insulin-sensitizing agents in the management of anovulatory infertile women with polycystic ovary syndrome (PCOS). MATERIALS AND METHODS: The search term of subfertile women with anovulation and PCOS was used for identification of randomized controlled trials. Nonrandomized controlled studies were identified through computer MEDLINE and EMBASE searches for the years 1980-2002. RESULTS: For obese PCOS women weight loss of > 5% of pretreatment weight restores menstrual regularity in 89%, of whom 30% achieved spontaneous pregnancy. It was estimated that 75-80% of anovulatory PCOS women will respond to clomiphene citrate (CC) and 35-50% will achieve pregnancy. For CC-resistant PCOS women (20-25%), CC + metformin (1.5 g/day) for 3-6 months has a 70% chance of restoration of regular menses and ovulation, and a 23% chance of pregnancy. Laparoscopic ovarian drilling (LOD) can be offered to CC-resistant PCOS women. There was no statistically significant difference in the ovulation rate following LOD with electrocoagulation and laser [83% vs. 77.5%; odds ratio (OR) 1.4; 95% CI 0.9-2.1], while there was a significantly higher cumulative pregnancy rate at 12 months after surgery (65% vs. 54.5%; OR 1.5; 95% CI 1.1-2.1). CONCLUSION: Diet and exercise followed by CC should be used for nonsurgical ovulation induction. For CC-resistant PCOS women, metformin may be included in a stepwise approach before a surgical approach. LOD with electrocautery is superior to laser drilling and gonadotropin therapy.     

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.