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目的探讨孕酮(P)撤退出血对无排卵多囊卵巢综合征(PCOS)患者来曲唑(LE)促排卵周期妊娠结局的影响。方法该研究为单中心前瞻性随机对照研究。利用随机数字表法,将纳入的169例无排卵PCOS患者,随机分为实验组(84例)及对照组(85例)。其中,实验组患者未经P撤退出血,直接接受LE促排卵治疗。对照组患者P撤退出血后再接受LE促排卵治疗。比较两组患者促排卵治疗过程中优势卵泡数目、hCG日E2水平、hCG日子宫内膜厚度、Gn用量及临床结局相关指标的差异。结果两组患者年龄、不孕年限、BMI、促排卵治疗前FSH及E2水平、促排卵治疗前的内膜厚度比较,差异无统计学意义(P>0.05);促排卵治疗过程中,两组患者14~18 mm卵泡数、≥18 mm卵泡数、hCG日E2水平、排卵率、生化妊娠率、流产率、取消周期率(OHSS发生率、卵巢反应不良发生率)比较,差异无统计学意义(P>0.05);实验组促排卵治疗前的LH水平、促排卵过程中hCG日内膜厚度、Gn用量、Gn使用天数均高于对照组,差异有统计学意义(P<0.05);与对照组相比,实验组临床妊娠率呈增高趋势,差异无统计学意义(P>0.05)。结论 P撤退出血可“削薄”无排卵PCOS患者接受LE促排卵治疗hCG日的子宫内膜厚度,使临床妊娠率呈下降趋势。处于基础状态的无排卵PCOS患者,可不经P撤退出血,直接及接受LE促排卵治疗。
Objective To investigate the effect of progesterone (P) withdrawal bleeding on the outcome of levodopa-induced pregnancy in patients with anovulatory polycystic ovary syndrome (PCOS). Methods This study was a single-center prospective randomized controlled study. A total of 169 cases of anovulatory PCOS patients were randomly divided into experimental group (84 cases) and control group (85 cases) using random number table method. Among them, the experimental group of patients without bleeding withdrawal, direct treatment of ovulation and ovulation LE. Control group patients with bleeding retreat after receiving LE ovulation therapy. The differences of the number of dominant follicles, the level of E2 on hCG day, the thickness of endometrium on hCG day, the amount of Gn and the clinical outcome were compared between the two groups. Results There was no significant difference in age, duration of infertility, BMI, FSH and E2 levels before ovulation induction, and intima thickness before ovulation induction (P> 0.05). During ovulation induction treatment, two groups There was no significant difference in the number of follicles of 14-18 mm, the number of follicles of ≥ 18 mm, the level of E2 on hCG, ovulation rate, biochemical pregnancy rate, miscarriage rate, cancellation cycle rate (OHSS incidence, incidence of ovarian dysfunction) (P> 0.05). The level of LH before ovulation induction, the thickness of intima-media thickness on day hCG, the amount of Gn and the number of days of Gn administration in experimental group were significantly higher than those in control group (P <0.05) Compared with the control group, the clinical pregnancy rate in experimental group showed an increasing trend, with no significant difference (P> 0.05). Conclusion P withdrawal bleeding can “thin ” anovulatory PCOS patients receiving LE ovulation induction treatment of hCG day endometrial thickness, the clinical pregnancy rate showed a downward trend. In the basic state of anovulatory PCOS patients, bleeding may be withdrawn without P, directly and receive LE ovulation treatment.