来曲唑和氯米芬临床促排卵效果的比较

来曲唑和氯米芬临床促排卵效果的比较

王一波,顾娟,郑大慈

(徐州市中心医院生殖中心,江苏徐州221009)

摘要:目的　比较芳香化酶抑制剂———来曲唑(LE)和氯米芬(CC)促排卵的临床疗效。方法　将62例不孕妇女随机分成2组,其中来曲唑组28例,氯米芬组34例,2组分别于月经周期第3～7天每天口服来曲唑2.5mg 或氯米芬50mg,均于月经第11天开始阴道B超监测卵泡大小和子宫内膜厚度。至最大卵泡平均直径(MF D)≥18mm时,肌注人绒毛膜促性腺激素(HCG)10000U。结果　肌注HCG当日最大卵泡M F D、周期排卵率、异位妊娠率2组比较,差异无统计学意义(P>0.05)。来曲唑组HCG日优势卵泡数、HCG日子宫内膜厚度、宫颈黏液评分、临床周期妊娠率均优于氯米芬组(P<0.05)。其中来曲唑组发生未破卵泡黄素化综合征(LUFS)1例,而氯米芬组有3例。2组均未出现卵巢过度刺激综合征。结论　来曲唑用于不孕妇女的促排卵治疗优于氯米芬,将来有可能替代氯米芬作为一线的诱发排卵药物。

关键词:不孕症;来曲唑;氯米芬;促排卵药物

中图分类号:R711.6 文献标志码:A 文章编号:1000-2065(2009)02-0097-03

L etrozole and clom i phene c itra te ovul a ti on com par ison of the cli n i ca l effects

W ang Yibo,Gu Juan,Zheng Daci

(Rep r oductive Medicine Center,Xuzhou Central Hos p ital,Xuzhou,J iangsu221009,China)

Abstract:O bjecti ve　To compare the clinical effects of letr ozole(LE)and cl om i phene citrate(CC)on ovulati on inducti on.M ethods　62infertile wo men with typeⅡrep r oductive endocrine abnor mality were random ly divided int o t w o gr oup s,with28women in LE gr oup and34women in CC gr oup.The women in both gr oup s t ook2.5mg letr ozole and 50mg cl om i phene citrate res pectively,once a day successively fr om the third t o the seventh day of menstrual peri od(5 days).The follicle dia meter and endometrial thickness were monit ored by the transvaginal ultras ound as of the eleventh day.W hen the max follicle dia meter(MF D)was≥18mm,the women were injected with hu man chori onic gonadotr op in (HCG)10000U intramuscularly.Results　No significant difference was f ound bet w een the t w o gr oup s inMF D on HCG days,cycle ovulati on rate and ect op ic p regnancy rate(P>0.05).LE gr oup had the higher average dom inant f ollicle numbers,endometrial thickness on HCG days,cervical mucus scores and clinical p regnancy rate than CC gr oup(P< 0.05).There was one patient with luteinized unrup tured follicle syndr ome(LUFS)in LE gr oup and three in CC gr oup. Neither of the gr oup s had ovary oversti m ulati on syndr ome.Conclusi on　Letr ozole has more advantage than cl om i phene citrate in ovulati on treat m ent of infertile women.It is expected t o rep lace cl om i phene citrate as a first-line drug t o in2 duce ovulati on.

Key words:infertility;letr ozole;cl om i phene citrate;ovulati on inducti on

排卵障碍是引起不孕的主要原因之一。氯米芬(CC)是目前临床应用最广的促排卵药物,但其对子宫内膜和宫颈黏液有潜在的不良影响,使其促排卵率高但妊娠率并不理想。近年来国内外许多学者逐渐将第3代芳香化酶抑制剂来曲唑(LE)用于育龄妇女的促排卵治疗[1]。2000年A l-Fozan等正式将其用于临床,并取得了良好的效果[2]。本中心分别用LE与CC对62例不孕妇女进行促排卵治疗并进行了对照研究,以探讨LE这一较新的促排卵药物在一线使用的可能性。1　资料和方法

1.1　研究对象

1.1.1　一般资料　选择2008年5～10月就诊于我院生殖中心的不孕妇女62例,年龄22～39岁,平均(29.15±4.12)岁。经排卵监测、内分泌激素测定等判定属于Ⅱ型生殖内分泌异常的不孕妇女[3]。

1.1.2　纳入标准　①年龄<40岁;②不孕病程>1年;③经输卵管通液术、子宫输卵管碘油造影术(HSG)或腹腔镜证实至少一侧输卵管通畅;④B