促排卵对不同病因患者宫腔内人工授精妊娠结局的影响

The effect of ovulation to the pregnancy outcome of IUI in infertile patients of different etiology

目的了解促排卵在不同病因患者中对宫腔内人工授精妊娠结局的影响,旨在更合理有效的应用促排卵技术,指导临床治疗。方法回顾性分析我中心2011年5月至2012年10月期间5167个宫腔内人工授精治疗周期,按不孕的原因将其分为少弱精子症组,多囊卵巢综合征组,不明原因不孕组,宫颈因素组,性功能障碍组,卵巢功能减退组,分别比较各病因组中促排卵及自然周期的宫腔内人工授精妊娠结局,了解其对妊娠结局的影响。结果在少弱精子症组、多囊卵巢综合征组、不明原因不孕组促排卵周期临床妊娠率高于自然周期,差异有统计学意义,多胎率高于自然周期但差异不具有显著性,流产率及宫外孕发生率差异无显著性。而在宫颈因素组,性功能障碍组,卵巢功能减退组促排卵周期与自然周期组比较,临床妊娠率、流产率、多胎率及宫外孕发生率差异不具有统计学意义,无患者发生卵巢过度刺激。结论促排卵可提高少弱精子症,多囊卵巢综合征及不明原因不孕导致的不孕症的临床妊娠率,使多胎率增加,对流产率、宫外孕发生率无明显影响。而对宫颈因素、性功能障碍、卵巢功能减退所致的不孕症的临床妊娠率、双胎率及宫外孕发生率均无明显影响。

Objective ： To explore the effect of ovulation to the pregnancy outcome of IUI in infertile patients of different etiology, aimed at a more reasonable application of ovulation effectively, to guide the clinical treatment. Methods： Retrospective analysis of 5167 intrauterine insemination cycles from May 2011 to October 2012 in our center, according to the cause of infertility all the patients were divided into the oligozoospermia ＆ asthenozoospermia group, polycystic ovary syndrome group, unexplained infertility group, cer- vical factor group, sexual dysfunction group, ovarian dysfunction group, the clinical pregnancy rate, abortion rate, multiple pregnancy rate and ectopic pregnancy rate were compared repectively in each group between ovulation induction and natural cycles. Results： The clinical pregnancy rate is higher in the ovulation cycle than the natural cycle in the patients with oligospermia ＆ asthenospermia, poly- cystic ovary syndrome and unexplained infertility, the difference was statistically significant, in those patients the multiple pregnancy rate is higher than the natural cycle, but the difference was not significant, the abortion and ectopic pregnancy rate had no significant difference in the two cycles. There is no difference in the clinical pregnancy rate, abortion rate, multiple pregnancy rate and ectopic pregnancy rate between the ovulation induction cycle and natural cycle in the paients with cervical factor, sexual dysfunction, ovarian dysfunction, no patients had mid and severe ovarian hyperstimulation. Conclusion： Ovulation can improve the clinical pregnancy rate in the paients with oligospermia ＆ asthenospermia, polycystic ovarian syndrome and unexplained infertility, the multiple pregnancy rate is also increased, but the difference is not different, There is no obvious effect in the patients with cervical factors, ovarian function decline, sexual dysfunction, endometriosis.