不同促排卵方案对宫腔内人工授精妊娠结局的影响

Effects of ovarian mild-stimulation protocols on pregnancy outcomes of intrauterine insemination patients

目的:探讨宫腔内人工授精(IUI)的最佳促排卵方案。方法:回顾性分析646个IUI周期,比较自然周期与促排卵周期、不同优势卵泡数目的促排卵周期、不同促排卵方案之间患者的临床妊娠率、多胎率、流产率的差异。结果:1促排卵周期人工授精临床妊娠率显著高于自然周期(20.84%vs 8.77%,P<0.05);2 h CG注射日优势卵泡数目1个、2个、3个之间的促排卵周期临床妊娠率分别为13.6%、24.14%、32.35%,差异有统计学意义(P<0.01);3氯米芬(CC)与CC联合尿促性腺激素(CC+h MG)2种促排卵方案相比,CC+h MG组与CC组比较,h CG注射日优势卵泡数(2.0±0.9 vs 1.5±0.3)、子宫内膜厚度(9.41±1.88 mm vs 8.06±1.92 mm)、妊娠率(22.13%vs 10.93%)差异均有统计学意义(P<0.05);来曲唑(LE)与LE+h MG 2种促排卵方案相比,LE+h MG组优势卵泡数显著大于LE组(1.6±0.7 vs 1.0±0.0,P<0.01),且临床妊娠率有增高的趋势。结论:各种促排卵方案能增加IUI临床妊娠率,CC或LE联合小剂量h MG的温和促排卵方案,能获得一个最为理想的临床结局。

Objective： To evaluate the best ovarian mild-stimulation protocol of intrauterine insemination （IUI） patients. Methods： A total of 646 IUI cycles were included, consisting of 171 nature cycles （NC） and 475 ovarian mild- stimulation cycles （OMC）. Clinical pregnancy rates （PR）, miscarriage rates （MR）, multiple pregnancy rates （MPR） between NCs and OMCs, different number of dominant follicles groups and ovarian mild-stimulation protocols were compared, respectively. Results： 1） PRs were significantly higher in OMC than in those NC （20.84%, 8.77%, P〈0.05）. 2） The clinical PRs were 13.60%, 24.14%, 32.35%, respectively on the day of human chorinonic gonadotrophin （hCG） administration when the number of dominant follicles was from 1 to 3.3） The number of dominant follicles and the thickness of endometrium on hCG injection day and PRs were more higher in CC＋hMG group than those in CC group （P〈0.05）. The number of dominant follicles was more in LE＋hMG group than in LE group （P〈0.05）, and the PRs in LE＋hMG group seemed higher, but with no statistic differences. Conclusion： Ovarian stimulation can increase the PR in IUI cycle. CC or LE with a low dose ofhMG, a mild ovarian stimulation protocol can get a satisfied pregnancy outcome.