下丘脑垂体性闭经应用HMG联合小剂量hCG促排卵成功妊娠4例分析及文献回顾
|
摘要
目的:探讨下丘脑垂体性闭经患者应用人绝经期促性腺激素(HMG)联合小剂量人绒毛膜促性腺激素(h CG)的促排卵疗效。方法:对4例下丘脑垂体性闭经患者HMG联合小剂量h CG促排卵和单纯应用HMG促排卵进行比较,观察血清激素水平、卵泡生长发育及妊娠结局。结果:4例患者应用HMG联合小剂量h CG 8个周期和单纯应用HMG促排卵4个周期比较,新方案优势卵泡数1~4个,周期妊娠成功率50%,无卵巢过度刺激综合征发生,均成功足月分娩。结论:HMG联合小剂量h CG促排卵能够安全有效地应用于下丘脑垂体性闭经的患者,可减少优势卵泡的数目,减少多胎风险。由于例数较少,尚需大规模临床试验进一步证实。
Objective:To investigate the effect of ovarian stimulation with HMG combined with low-dose of h CG on those inferlity patients with hypogonatropic hypogonadism and amenorrhea. Methods: Four infertility patients with hypogonatropic hypogonadism and amenorrhea were treated with HMG and low-dose of h CG for two cycles after one treatment with only HMG for four cycle, as for their ovarian stimulation. Follicular development was monitored by vaginal ultrasound-B and serum sexual hormone. Results: Totally, there were 4 cycles of only HMG treatment, and 8 cycles of HMG +h CG treatment. Compared with the only HMG cycles, the HMG +h CG cycles had the number of dominant follicles between 1 and 4, the cumulating pregnancy rate 50%, no moderate and severe OHSS, and a term birth for every patient. Conclusions: The protocol of HMG combined with low-dose of h CG can be tried in those infertility patients with hypogonatropic hypogonadism for ovarian stimulation. However,the safety and efficiency of this combined protocol should be tested by other clinical trials and large samples.
Objective:To investigate the effect of ovarian stimulation with HMG combined with low-dose of h CG on those inferlity patients with hypogonatropic hypogonadism and amenorrhea. Methods: Four infertility patients with hypogonatropic hypogonadism and amenorrhea were treated with HMG and low-dose of h CG for two cycles after one treatment with only HMG for four cycle, as for their ovarian stimulation. Follicular development was monitored by vaginal ultrasound-B and serum sexual hormone. Results: Totally, there were 4 cycles of only HMG treatment, and 8 cycles of HMG +h CG treatment. Compared with the only HMG cycles, the HMG +h CG cycles had the number of dominant follicles between 1 and 4, the cumulating pregnancy rate 50%, no moderate and severe OHSS, and a term birth for every patient. Conclusions: The protocol of HMG combined with low-dose of h CG can be tried in those infertility patients with hypogonatropic hypogonadism for ovarian stimulation. However,the safety and efficiency of this combined protocol should be tested by other clinical trials and large samples.
引文
[1]于淼,邓成艳,孙正怡,等.促性腺激素对于下丘脑-垂体性闭经不育患者助孕治疗的疗效观察[J].生殖医学杂志,2010,19(4):301-304.
[2]傅永伦,匡延平.小剂量h CG联合HMG对低促性腺激素性腺功能减退症不育患者卵巢刺激的疗效观察[J].国际妇产科学杂志,2011,38(5):465-467.
[3]徐艳文,朱莉,古芳,等.低促性腺激素性腺功能减退症的促排卵治疗——附2例临床分析[J].生殖与避孕,2012,32(9):627-629.
[4]中华医学会妇产科学分会内分泌学组,田秦杰.闭经诊断与治疗指南(试行)[J].中华妇产科杂志,2011,46(9):712-716.
[5]Tanmahasamut P,Rattanachaiyanont M,Dangrat C,et al.Causes of primary amenorrhea:a report of 295 cases in Thailand[J].J Obstet Gynaecol Res,2012,38(1):297-301.
[6]Filicori M,Cognigni GE,Taraborrelli S,et al.Low-dose human chorionic gonadotropin therapy can improve sensitivity to exogenous follicle-stimulating hormone in patients with secondary amenorrhea[J].Fertil Steril,1999,72(6):1118-1120.
[7]Lee KL,Couchman GM,Walmer DK.Successful pregnancies in patients with estrogenic anovulation after low-dose human chorionic gonadotropin therapy alone following h MG for controlled ovarian hyperstimulation[J].J Assist Reprod Genet,2005,22(1):37-40.
[8]Balasch J,Fábregues F,Carmona F,et al.Ovarian luteinizing hormone priming preceding follicle-stimulating hormone stimulation:clinical and endocrine effects in women with long-term hypogonadotropic hypogonadism[J].J Clin Endocrinol Metab,2009,94(7):2367-2373.
[9]Tsutsumi R,Fujimoto A,Osuga Y,et al.Successful pregnancy following low-dose h CG administration in addition to h MG in a patient with hypothalamic amenorrhea due to weight loss[J].Gynecol Endocrinol,2012,28(6):460-462.
[10]吴晓燕,宋玉,李志凌,等.下丘脑-垂体性闭经不孕患者30个助孕周期治疗分析[J].中国伤残医学,2014,22(16):97-99.
[11]潘萍,杨冬梓.低剂量绒促性素与控制性卵巢刺激[J].实用妇产科杂志,2016,32(1):19-21.
[12]Shen ZQ,Xu JJ,Lin JF.Resumption of menstruation and pituitary response to gonadotropin-releasing hormone in functional hypothalamic amenorrhea subjects undertaking estrogen replacement therapy[J].J Endocrinol Invest,2013,36(10):812-815.
[13]Gurgan T,Demirol A.Recombinant luteinizing hormone in assisted reproductive technology[J].Rev Gynaecol Pract,2005,5(1):45-50.
[14]Mc Gee EA,Hsueh AJ.Initial and cyclic recruitment of ovarian follicles[J].Endocr Rev,2000,21(2):200-214.
[15]Lévy DP,Navarro JM,Schattman GL,et al.The role of LH in ovarian stimulation:exogenous LH:let′s design the future[J].Hum Reprod,2000,15(11):2258-2265.
[16]Castillo JC,Dolz M,Bienvenido E,et al.Cycles triggered with Gn RH agonist:exploring low-dose HCG for luteal support[J].Reprod Biomed Online,2010,20(2):175-181.
[2]傅永伦,匡延平.小剂量h CG联合HMG对低促性腺激素性腺功能减退症不育患者卵巢刺激的疗效观察[J].国际妇产科学杂志,2011,38(5):465-467.
[3]徐艳文,朱莉,古芳,等.低促性腺激素性腺功能减退症的促排卵治疗——附2例临床分析[J].生殖与避孕,2012,32(9):627-629.
[4]中华医学会妇产科学分会内分泌学组,田秦杰.闭经诊断与治疗指南(试行)[J].中华妇产科杂志,2011,46(9):712-716.
[5]Tanmahasamut P,Rattanachaiyanont M,Dangrat C,et al.Causes of primary amenorrhea:a report of 295 cases in Thailand[J].J Obstet Gynaecol Res,2012,38(1):297-301.
[6]Filicori M,Cognigni GE,Taraborrelli S,et al.Low-dose human chorionic gonadotropin therapy can improve sensitivity to exogenous follicle-stimulating hormone in patients with secondary amenorrhea[J].Fertil Steril,1999,72(6):1118-1120.
[7]Lee KL,Couchman GM,Walmer DK.Successful pregnancies in patients with estrogenic anovulation after low-dose human chorionic gonadotropin therapy alone following h MG for controlled ovarian hyperstimulation[J].J Assist Reprod Genet,2005,22(1):37-40.
[8]Balasch J,Fábregues F,Carmona F,et al.Ovarian luteinizing hormone priming preceding follicle-stimulating hormone stimulation:clinical and endocrine effects in women with long-term hypogonadotropic hypogonadism[J].J Clin Endocrinol Metab,2009,94(7):2367-2373.
[9]Tsutsumi R,Fujimoto A,Osuga Y,et al.Successful pregnancy following low-dose h CG administration in addition to h MG in a patient with hypothalamic amenorrhea due to weight loss[J].Gynecol Endocrinol,2012,28(6):460-462.
[10]吴晓燕,宋玉,李志凌,等.下丘脑-垂体性闭经不孕患者30个助孕周期治疗分析[J].中国伤残医学,2014,22(16):97-99.
[11]潘萍,杨冬梓.低剂量绒促性素与控制性卵巢刺激[J].实用妇产科杂志,2016,32(1):19-21.
[12]Shen ZQ,Xu JJ,Lin JF.Resumption of menstruation and pituitary response to gonadotropin-releasing hormone in functional hypothalamic amenorrhea subjects undertaking estrogen replacement therapy[J].J Endocrinol Invest,2013,36(10):812-815.
[13]Gurgan T,Demirol A.Recombinant luteinizing hormone in assisted reproductive technology[J].Rev Gynaecol Pract,2005,5(1):45-50.
[14]Mc Gee EA,Hsueh AJ.Initial and cyclic recruitment of ovarian follicles[J].Endocr Rev,2000,21(2):200-214.
[15]Lévy DP,Navarro JM,Schattman GL,et al.The role of LH in ovarian stimulation:exogenous LH:let′s design the future[J].Hum Reprod,2000,15(11):2258-2265.
[16]Castillo JC,Dolz M,Bienvenido E,et al.Cycles triggered with Gn RH agonist:exploring low-dose HCG for luteal support[J].Reprod Biomed Online,2010,20(2):175-181.