对小卵泡排卵不同助孕方式的相关研究

The study of different ways of assisted reproduction in treating small follicle ovulation OSF

目的比较三种不同助孕方式用于小卵泡排卵性不孕患者的促排卵效果及妊娠结局,寻找一种更加安全高效的治疗方法。方法前瞻性分析301例小卵泡排卵患者的455个自然监排周期和459个促排卵助孕周期,根据患者输卵管情况及配偶精液结果,在病人知情同意条件下分为用药促排组、宫腔内夫精人工授精(AIH)组、体外受精-胚胎移植(IVFET)组。B超监测卵泡发育情况,并根据具体发育情况决定促排用药及剂量。比较三组间排卵日/HCG日优势卵泡(≥15mm)数、最大卵泡直径、Lufs发生率、OHSS发生率、周期妊娠率、异位妊娠率、多胎率及早期流产率。结果经以上助孕方式治疗后IVF-ET组的HCG日优势卵泡(≥15mm)数、周期妊娠率均高于其他两组,Lufs发生率低于其他组,差异均有统计学意义(P<0.05)。IVF-ET组OHSS发生率及多胎率高于其他组,但差异无统计学意义(P>0.05)。在用药促排组及AIH组中应用克罗米芬(CC)、尿促性素(HMG)、CC+HMG的三种用药方案中,CC+HMG周期妊娠率最高,差异有统计学意义(P<0.05);该用药早期流产率最低,差异无统计学意义(P>0.05)。结论药物促排卵治疗对小卵泡排卵的患者有明显疗效;促排药物使用CC)联合HMG则有利于减轻CC的副作用,避免HMG引起的卵泡过小即排卵的情况,提高妊娠率,降低流产率;在药物促卵泡发育的同时,根据患者适应症采用辅助助孕技术AIH或IVF可进一步提高妊娠率,是小卵泡排卵较为安全有效的治疗方案。

Objective： To explore the best therapy of infertile women ovulated with small follicle （OSF） by comparing the stimulate ovulation effect and pregnancy outcomes of four kinds of assisted reproductive technology （ART） used in the treatment of OSF. Methods： 301 infertile women caused by OSF, who had 455 clinical cycles and 459 ART cycles were analyzed prospectively. According to the results of hystero-salpingography and spouse semen there are three groups used in the patients： Artificial medication cycle, AIH cycle, IVF cycle under the condition of patients＇ informed consent. Transvaginal ultrosonography was used to monitor the follicular development and drug ovulation facilitation for them. Compare the number of the dominant follicle in HCG day, rates of Lufs incidence, OHSS incidence, pregnancy, ectopic pregnancy, polyembryony, early abortion and so on. Results： After treatments of these ARTs, the number of the dominant follicle in HCG day, rates of pregnancy in IVF-ET group were higher than that in other groups, the rate of Lufs incidence is lower than others. And the rates of polyembryony and OHSS incidence were higher than other groups.In the Artificial medication treatment, the rates of pregnancy in CC＋HMG group were higher than other groups, the rate of early abortion incidence is lower than others. Conclusions： Stimulating ovulation drugs can increase the pregnancy rates of patient with OSF. Using CC joint HMG will reduce the side effects of CC, avoid causing too small follicles that HMG treatment, and increase pregnancy rate and reduce the abortion rate. During stimulating follicle growth, AIH and IVF are the safe and effective therapies for OSF patients because of higher clinical pregnancy rate.