Elbohoty Ahmed E H, Amer Mohamed, Abdelmoaz Mohamed
Department of Obstetrics and Gynecology, Faculty of Medicine, AinShams University, Abbasia, Cairo, Egypt.
J Obstet Gynaecol Res. 2016 Aug;42(8):966-71. doi: 10.1111/jog.12996. Epub 2016 Apr 28.
To compare the ovarian response to early versus late clomiphene citrate (CC) in women with polycystic ovary syndrome (PCOS).
This cross-over randomized controlled clinical trial included 90 infertile amenorrheic women with PCOS. After inducing withdrawal bleeding, patients were randomly divided into two equal groups to receive ovulation induction with CC 100 mg/day for 5 days. Group I started treatment the next day after finishing medroxyprogesterone acetate course for a menstrual cycle, and after a washout period of another menstrual cycle, the treatment was shifted to start on day 2 of withdrawal bleeding. Group II received a reversed protocol: late then early treatment. Women were followed up on transvaginal ultrasonography to monitor follicular growth, endometrial thickness and evidence of ovulation. Human chorionic gonadotropin 10 000 IU was given i.m. to trigger ovulation when at least one mature follicle measured ≥18 mm at day 14.
In all cases, early induction protocol resulted in significantly higher proportion of ovulating patients, thicker endometrium and higher number of follicles 14-17 mm in diameter, ≥ 18 mm in diameter and total number of follicles (P < 0.001 for all comparisons).
In women with PCOS, early initiation of CC before withdrawal bleeding or during the last days of the luteal phase can achieve a better ovulatory response.
比较多囊卵巢综合征（PCOS）女性对早期与晚期克罗米芬（CC）的卵巢反应。
这项交叉随机对照临床试验纳入了90例患有PCOS的不孕闭经女性。诱导撤退性出血后，患者被随机分为两组，每组人数相等，接受每天100mg CC共5天的促排卵治疗。第一组在完成醋酸甲羟孕酮疗程后的下一个月经周期的第二天开始治疗，经过另一个月经周期的洗脱期后，治疗改为在撤退性出血的第2天开始。第二组接受相反的方案：晚期治疗后再进行早期治疗。通过经阴道超声对女性进行随访，以监测卵泡生长、子宫内膜厚度和排卵情况。当在第14天至少有一个成熟卵泡直径≥18mm时，肌内注射10000IU人绒毛膜促性腺激素以触发排卵。
在所有病例中，早期诱导方案导致排卵患者比例显著更高、子宫内膜更厚，直径14 - 17mm、≥18mm的卵泡数量以及卵泡总数更多（所有比较P < 0.001）。
对于PCOS女性，在撤退性出血前或黄体期最后几天早期开始使用CC可获得更好的排卵反应。
