宫腔人工授精中不同促排卵方案的临床效果比较

Comparison of clinical effects of different ovulation induction in intrauterine artificial insemination

目的探讨在宫腔人工受精(IUI)中不同促排卵方案的治疗效果。方法纳入促排卵并行IUI的不孕患者109例共163个周期,分为5组,A组为来曲唑;B组为氯米芬;C组为来曲唑联合尿促性素(HMG);D组为氯米芬联合HMG;E组为HMG;月经周期第8天超声监测卵泡发育。当优势卵泡≥20 mm,或尿黄体生成素(LH)阳性,肌肉注射人绒毛膜促性腺激(HCG)10000 IU,之后24～36h进行IUI;观察成熟卵泡数、子宫内膜厚度、排卵率、妊娠率、多胎妊娠率、卵巢过度刺激综合征(OHSS)。结果与B组比较,C组,D组HCG日成熟卵泡数目高于对照组,差异有统计学意义(P<0.05);E组的子宫内膜厚度高于对照组,差异有统计学意义(P<0.05)。排卵率C组最高为96.8%;B组最低为85.7%,差异无统计学意义(P>0.05);妊娠率E组为25.0%最高;B组为4.8%最低,差异无统计学意义(P>0.05);D组发生双胎妊娠2例,C组发生双胎妊娠1例,A组发生四胎妊娠1例。C组发生OHSS1例。结论在IUI中各种促排卵方案获得的临床妊娠率差异无统计学意义;HMG能促进多个卵泡生长及子宫内膜发育,联合用药可弥补单用氯米芬导致的内膜薄等缺点,增加临床妊娠率;促排卵过程中须重点控制优势卵泡数量,尽可能减少OHSS及多胎妊娠的发生。

Objective：To discuss clinical effects of different ovulation induction in intrauterine artificial insemination.Methods：Infertile patients of 163 cycles of 109 cases received ovulation induction and IUI were included.A group of letrozole;B group clomiphene;C group,letrozole joint HMG;D group clomiphene joint HMG;E group HMG;When the dominant follicle ≥ 20 mm,or urinary LH（＋）,intramuscular injection of human chorionic gonadotropin（HCG） 10000 IU,after 24 ～ 36 h for IUI;observation of the use of HMG total number of mature follicles,endometrial thickness,ovulation rate,pregnancy rate,Multiple pregnancy rate Ovarian hyperstimulation syndrome（OHSS）.Results：Compared with B group,C group,the number of mature follicles injected with hCG day of D group higher than the control group,the difference was statistically significant（P0.05）;endometrial thickness of E group higher than the control group,the difference was statistically significant（P0.05）.Ovulation rate of C group was the highest and 96.8%;B group was lowest and 85.7%,the difference was not statistically significant（P 0.05）;pregnancy rate of E group was the highest and 25.0%;B group was lowest and 4.8% the difference was not statistically significant（P 0.05）;D group twin pregnancy occurred in 2 cases,C group 1 case of twin pregnancy occurred,A group of four pregnancies occurred in 1 case.C group occurred OHSS1 cases.Conclusions：Clinical pregnancy rate in IUI obtained from different ovulation induction was no significant difference;HMG can promote multiple follicular growth and endometrial development,combination therapy can be used to make up for disadvantages such as thin endometrial resulted from clomiphene and increased clinical pregnancy rate;the number of dominant follicle must be focused on during ovulation induction and to minimize the occurrence of OHSS and multiple pregnancies as far as possible.