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目的:分析影响克罗米芬(clomiphene,CC)治疗效果的相关因素,寻找改善临床疗效的途径。方法:选择排卵障碍性不孕患者158例,根据雌激素补充时间分为:A组:月经第8天开始每日口服补佳乐2 mg;B组于卵泡直径14 mm后根据内膜厚度每日口服给予补佳乐4~6 mg。根据HCG日最大卵泡直径分为:18 mm~20 mm(C组);21 mm~23 mm(D组);≥24 mm(E组)。比较各组优势卵泡数、卵泡生长天数、血雌二醇(E2)水平、子宫内膜厚度、未破裂卵泡黄素化(LUF)、周期临床妊娠率。结果:HCG注射日卵泡生长天数、优势卵泡个数和血E2水平A、B两组之间无统计学差别;而宫内膜厚度和临床妊娠率A组高于B组(P<0.05)。HCG日最大卵泡直径21 mm~23 mm组,LUF发生率最低,临床妊娠率最高(P<0.05)。结论 :早卵泡期开始补充小剂量雌激素,适当推迟HCG注射时间有助于增加子宫内膜厚度,减少LUF发生率,进而提高CC促排卵治疗的临床妊娠率。
Objective: To analyze the related factors that affect the therapeutic effect of clomiphene (CC) and find ways to improve the clinical curative effect. Methods: According to the time of estrogen supplementation, 158 cases of infertility with ovulation disorder were selected. Group A: daily norepinephrine 2 mg was started on the 8th day of menstruation; in group B, follicular diameter 14 mm, Day oral administration of norepinephrine 4 ~ 6 mg. According to the HCG largest follicular diameter is divided into: 18 mm ~ 20 mm (C group); 21 mm ~ 23 mm (D group); ≥ 24 mm (E group). The number of dominant follicles, days of follicle growth, E2 level, endometrial thickness, LUF, and clinical pregnancy rate were compared between groups. Results: There was no significant difference between the days of follicle growth, the number of dominant follicles and the level of serum E2 on the day of HCG injection, while the endometrial thickness and clinical pregnancy rate in group A were higher than those in group B (P <0.05). The largest follicle size of 21 mm ~ 23 mm in HCG group was the lowest, with the highest clinical pregnancy rate (P <0.05). CONCLUSIONS: Early follicular phase supplementation of small doses of estrogen, the appropriate postponement of HCG injection time will help to increase the thickness of the endometrium, reduce the incidence of LUF, thereby increasing the clinical ovulation induction CC pregnancy rate.