The Effect Of Body Mass Index On The Treatment And Early Pregnancy Outcome Of PCOS Infertility With Clomiphene Combined With HMG

Objective: To study the effect of body mass index(BMI)on the treatment of the infecund patients of polycystic ovary syndrome with clomiphene combined and menopausal gonadotropin ovulation induction.Methods: A retrospective study was conducted on 355 cases of PCOS patients who were infertility for more than 12 months and were treated from the end of January 2015 to January 2016 in the Reproductive Center of Dalian Maternal and Child Health Hospital.According to BMI will be divided into four groups :(1)normal body weight group(18.5 ? BMI <23kg / m2): 130 cases;(2)low weight group(<18.5kg / m2): 30 cases;overweight group(23(3)?BMI < 25 kg / m2): 50 cases;obese group((4)?25kg / m2): 125 cases.In the menstrual cycle 2-4 days(the date of amenorrhea patients is not limited),collected the fasting elbow venous blood to determinate the basic endocrine.IncludingEstradiol(E2),Testosterone(T),FollicleStimulating Hormone(FSH),Luteinizing Hormone(LH),Fasting Blood Glucose(FBG)and Serum Insulin(FINS).It needed to calculated the LH / FSH and the insulin resistance index(IR,IR = fasting blood glucose × fasting serum insulin ÷ 22.5)that was calculated by steady state model.Exclude the relevant taboos,In the menstrual cramps on the 5th day,began to oral clomiphene 50mg/d,a total of 5d,meanwhile oral estradiol valerate,1mg/d,until the follicle mature ovulation.In the menstrual period 10-12 days,Ultrasonic monitored the number of the dominant follicles.Began to use HMG by intramucular injection everyday.The use of the dose depended on the size of the follicular.The maximum daily dose not more than 225 IU.The follicle and endometrial growth were monitored by vaginal ultrasonography every 2 days.When the average diameter of follicles ? 16 mm,began to monitor every day.When the maximum follicle diameter ? 18 mm,induced ovulation by intramuscular injection of HCG10000 IU.Patients mated within 24 ~ 48 h with HCG,After injected HCG 48 ~ 72 h,vaginal B ultrasound monitored ovulation.After ovulation,oral progesterone capsules,2 capsules daily,taking 12 consecutive days to maintain the corpus luteum function.After ovulation 14 days without menstrual cramps,check blood HCG.When HCG ? 25 IU / L,it is diagnosed biochemical pregnancy.After ovulation 4 weeks,B intrauterine find a gestational sac is clinical pregnancy.Early abortion is a spontaneous abortion 12 weeks before clinical pregnancy.The general data(age,infertility),hormone levels,IR,period menopausal gonadotropin dosage and medication time,ovulation rate,clinical pregnancy rate and pregnancy outcome were compared between the above groups.Results: 1.There was no statistically significant difference between the four groups in the general data(P> 0.05)2.There were some differences in the levels of Hormones in the four groups.There was no significant difference in the E2 values between the four groups(P> 0.05).With the increase of body mass index,LH / FSH gradually decreased,and overweight,obese group compared with the normal group,there was a statistically significant(P <0.05);With the increase of body mass index,T value and IR value also increased gradually,and overweight and obesity groups were significantly higher than those of normal group Statistical significance(P <0.05).3.The amount of HMG used and the time of administration were lower than that of normal body weight group,but the difference was not statistically significant(P = 0.51,P> 0.05;P = 0.68,P> 0.05).The amount and the time of HMG used in the overweight,obese groups were significantly higher than that the normal body weight group(P <0.05;P <0.05).4.There was no significant difference in ovulation rate between the four groups(P> 0.05).There was no significant difference in clinical pregnancy rate,spontaneous abortion rate and biochemical pregnancy rate between the low body weight group and the normal body weight group(P> 0.05).There were significant differences in clinical pregnancy rate,spontaneous abortion rate and biochemical pregnancy rate between the overweight group,the obese group and the normal body weight group(P <0.05).Conclusion: The body mass index has a certain effect on the presence of Croomifene combined with HMG in the treatment of PCOS infertility.Testosteroneand IR levels of overweight,obese PCOS patients were higher than the normal weight PCOS patients,the body of the hormone disorder is more serious.And high BMI can lead to PCOS in the process of promoting the increase in the amount of HMG and medication time,and can reduce the clinical pregnancy rate of PCOS,increase the risk of biochemical pregnancy and spontaneous abortion.Recommended appropriate weight loss,is conducive to PCOS patients with ovulation therapy and maternal outcome.The relationship between insulin resistance,leptin and poor pregnancy outcomes are subject to our more in-depth study and exploration.On the impact of low body weight on PCOS emission,due to the small number of samples,this study has not yet reached the impact of the conclusions,to be further confirmed by clinical studies.