| Objective: In this study, the levels of plasma renin activity (PRA), angiotensinⅡ(ATⅡ),growth hormone (GH), sex hormone and insulin (INS) were detected before and after taking cyproterone acetate Co. (CPA Co.) with polycystic ovary syndrome (PCOS) patients. The purpose was to investigate the effect of CPA Co. on PCOS patient's renin-angiotensin system (RAS) and secretion of pituitary GH. The effect of CPA Co. on PCOS patient's induced ovulation was evaluated with controlled clinical study. The mechanism of CPA Co. treatment before induced ovulation of PCOS patients was discussed.Materials and Methods: Forty-five proven PCOS patients were enrolled who were 21-32 aged, primary infertility. There were 21 obese patients (BMI≥25Kg/m2) and 24 nonobese patients. They were separated into two groups at random. The study group included thirty patients and the control group included fifty patients. The patients of study group were treated daily with CPA Co from day 5 to day 26 of natural menstruation or withdrawal bleeding for three cycles. After stopping the drug, they accepted thetreatment of induced ovulation. The patiens of control group accepted the treatment of induced ovulation directly after completing all examinations and excepting other infertile factors.Fasting blood samples of all patients were obtained on day 3 to 5 of the menstrual cycle or withdrawal bleeding. All samples were used to assess serum levels of LH, FSH, T, A, E2, fasting INS, fasting glucose, PRA, ATⅡ, GH Most of parameters were measured with RIA. Samples of study group were obtained and assessed again after three cycles of treatment. Side effects of CPA Co. such as vagina irregular bleeding, nausea, disgorge, ect were evaluated by means of patients'talk. The changes of blood pressure, weight, hirsutism and acne were observed.Bilateral ovarian volume and follicle numbers of study group patients were measured with vaginal ultrasound (US) before and after CAP Co. treatment.The protocol of induced ovulation was clomiphene (CC) + HMG/FSH low dose step-up regimen for the two groups. All patients took CC 50-150mg on days 3-5 of menstruate or withdrawal bleeding. Transvaginal ultrasound follicular monitoring was started on days 9 of the cycle and began to give them HMG /FSH one ample per day. The first increase in dose of HMG /FSH was based on absence of a follicle 10mm or larger after 7 days. The dose was increased by a half-ample per day 7 days if ovarian response was lack.The cycle would be canceled if there was no dominant follicle after 35 days of ovarian stimulation. The transvaginal US was performed every 3-4 days, when the mean diameter of the lead follicle was≥14mm, transvaginal US would be performed every day and the urine LH level would be monitored. Human chorionic gonadotropin (HCG) 5000-10000IU would be given when the mean diameter of the lead follicle was 20±2mm. If there was ≥3 follicles with the mean diameter ≥16, the patient would be given Buserelin 300ug (Suprecur, Hoechst AG). After injecting HCG or Buserelin 24-48 hours patients would be given artificial insemination by husband semen (AIH) or conducted sex among ovulation period. Ovulation and ovarian hyperstimulation (OHSS) would be mointored. Luteal support was provided with HCG (2000IU) every 3days or progesterone 20mg every day until 14 days after ovulating. If there was no ovulation in 96 hours after injecting HCG, and the lead follicle was growing continuously, basic tempareture had increased, that would be diagnosed as luteinizing unruptured follicle syndrome (LUFS). Pregnancy diagnosis was confirmed by ultrasound, clinical pregnancy would be determined with intrauterine gestational sac. after 4 weeks of ovulation.Statistics analysis was performed with the SPSS/PC package. All data are presented as the mean±SD. The significant differences of study group data before and aftertaking CPA Co. was tested with t test. The possible correlation of PRA, AT, GH with other factors of PCOS was analyzed with Birariate correlation anal... |
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