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目的:探讨来曲唑(LE)促排卵的个体化用药方法。方法:①收集近期不孕症门诊Ⅱ型排卵障碍患者78例、185个促排卵周期,其中多囊卵巢综合征(PCOS)152周期,其他排卵障碍33周期。②以诊断为依据选择LE启动剂量为2.5 mg和5.0 mg;适时添加HMG。③起始用药时间多于月经第5天开始,超过月经5天以上者,在内膜厚度<6 mm且处于增生期(A型)的前提下直接启动;用药天数以5天为准,根据卵巢反应性适度增减。结果:①153(82.3%)周期使用5.0 mg,32(17.7%)周期使用2.5 mg;PCOS 135(88.8%)周期使用5.0 mg,17(11.2%)周期使用2.5 mg;47(25.4%)周期辅以HMG。②月经周期3～5天启动163(88.1%)周期;6～8天启动17(9.2%)周期;9天以上启动5(2.7%)周期;用药3～5天171(92.4%)周期,6～7天13(7.0%)周期,8～9天1(0.6%)周期。③11周期促排卵失败,174周期成功,成功率94.1%;62例成功妊娠,累计周期妊娠率79.5%,每排卵周期妊娠率33.5%;成功妊娠者平均促排卵2.4周期;每周期平均排卵数1.2个;双胎妊娠1例,无中度以上卵巢过激综合征(OHSS)。结论:通过以诊断为依据选择合适的剂量并适时辅以HMG、灵活掌握启动时间和用药天数等个体化用药方法,能明显提高LE的促排卵效率。
Objective: To study the individualized medication of letrozole (LE) to promote ovulation. Methods: ①To collect 78 cases of type Ⅱ ovulation disorder and 185 cycles of ovulation induction, including 152 cycles of polycystic ovary syndrome (PCOS) and 33 cycles of other ovulation disorders. ② based on the diagnosis of choice LE startup dose of 2.5 mg and 5.0 mg; timely HMG. ③ start the medication more than the first 5 days of menstruation, more than 5 days of menstruation, intimal thickness <6 mm and in the proliferative phase (A type) under the premise of direct start; the number of days to 5 days, according to Ovarian response moderate increase or decrease. Results: ①15 weeks (82.3%) used 5.0 mg, 32 (17.7%) used 2.5 mg; PCOS 135 (88.8%) used 5.0 mg cycles, 17 With HMG. ② menstrual cycle 3 to 5 days to start 163 (88.1%) cycles; 6 to 8 days to start 17 (9.2%) cycles; 9 days to start 5 (2.7%) cycles; 3 to 5 days 171 (92.4% 6 to 7 days 13 (7.0%) cycles, 8 to 9 days 1 (0.6%) cycles. (3) failure to promote ovulation in 11 cycles, success in 174 cycles, the success rate of 94.1%; 62 cases of successful pregnancy, the cumulative cycle rate of 79.5%, 33.5% of ovulation cycles per cycle; successful pregnancy average ovulation 2.4 cycles; One case of twin pregnancy, no more than moderate ovarian hyperstimulation syndrome (OHSS). CONCLUSION: Through the diagnosis based on the selection of the appropriate dose and timely supplemented with HMG, flexible control of start-up time and the number of days of medication and other individual medication can significantly improve the ovulation efficiency of LE.