促排卵方案、授精次数对排卵障碍患者宫腔内人工授精临床结局的影响

Influence of induced ovulation protocol and insemination times on pregnancy outcome in intrauterine insemination

目的通过分析排卵障碍患者行促排卵宫腔内人工授精(IUI)治疗时不同促排卵方案、人工授精次数对临床结局的影响,提出最佳的促排卵IUI治疗策略。方法回顾性分析本中心2010年1月至2015年9月因排卵障碍行促排卵IUI治疗的患者共437个周期,按照不同促排卵方案分为5组:A组152个周期,采用氯米芬(CC)促排卵;B组65个周期,采用来曲唑(LE)促排卵;C组130个周期,采用CC+人绝经期促性腺激素(HMG)促排卵;D组38个周期,采用LE+HMG促排卵治疗;E组52个周期,采用HMG促排卵治疗。比较各组一般情况、临床特征、治疗结局,并分析行单次IUI和双次IUI治疗的患者临床结局。结果 (1)5种不同促排卵方案中,各组患者平均年龄、不孕年限、基础FSH、LH、BMI均无统计学差异(P>0.05)。(2)5组患者的临床妊娠率以A组最低为13.82%,B组为18.46%、C组为23.85%、D组为18.42%、E组为19.23%,各组间无统计学差异(P>0.05);A组、C组分别发生4例、2例多胎妊娠,其余各组无多胎妊娠发生;各组均无OHSS病例发生。(3)优势卵泡为1个的患者临床妊娠率(14.49%)显著低于优势卵泡2个者(24.17%)、3个者(29.27%)组,差异有统计学意义(P<0.05);优势卵泡2个者组和3个者组临床妊娠率无统计学差异(P>0.05);优势卵泡2个者组发生了5例多胎妊娠,其余各组无多胎妊娠发生。(4)单次和双次IUI的临床妊娠率(18.84%vs.17.59%)比较无统计学差异(P>0.05),且不同数目优势卵泡组的单、双次IUI临床妊娠率亦无统计学差异(1个者组14.63%vs.14.08%,2个以上者组25.81%vs.24.32%)(P>0.05)。结论排卵障碍患者行不同促排卵方案IUI的临床妊娠率相似,其中LE、LE+HMG方案能获得较好的临床妊娠率,且多胎妊娠的发生率较低,安全有效;多卵泡发育能提高临床妊娠率,但是增加多胎妊娠风险;同一周期行2次IUI并不能提高临床妊娠率,不应盲目使用。

Objective： To analyze the impact of different induced ovulation protocols and artificial insemination times on clinical outcomes of IUI for patients with ovulation disorders. Methods： The data of 437 IUI cycles in our center from January 2010 to September 2015 were retrospectively analyzed. The cycles were divided to 5 groups according to different induced ovulation protocols used：group A with clomiphene （n= 152） ; group B, letrozole （n =65） ; group C, clomiphene4- HMG （n= 130） ; group D, letrozole＋ HMG （n= 38） ; group E, HMG （n = 52）. The general condition, clinical characters and pregnant outcomes were compared among the five groups. The clinical outcomes were also compared between once and twice IUI treatment. Results： There are no differences in patients age,infertility duration,basal FSH/LH and BMI amongthe five groups （P〉0.05）. The clinical pregnancy rates （13.82% vs. 18.46% vs. 23.85% vs. 18. 42% vs. 19.23%） were not significant different among the five groups （P〉0.05）. There were four cases of multiple pregnancies in group A and two cases in group C. No ovarian hyperstimulation syndrome （OHSS） happened in all the groups. The clinical pregnancy rate in the patients with one dominant follicle （14.49%） was significantly lower than that in the patients with two （24.17%） or three （29.27%） dominant follicles （P〈0.05）. There was no significant difference in pregnancy rate between the patients with 2 and 3 dominant follicles （P〉0. 05）. There were five cases of multiple pregnancies in the patients with two follicles, but no multiple pregnancies happened in other groups. As regarding to artificial insemination times,there was no difference in clinical pregnancy rate（18.84% vs. 17.59%）between once and twice times of IUI （P〉0.05）. There were also no differences in clinical pregnancy rate among the patients with different numbers of dominant follicles（P〉0.05）. Conclusions. Clinical pregnancy rates are similar among the patients with different induced ovulation protocols. The patients with letrozole or letrozole＋ HMG protocol obtained better clinical pregnancy rate, and lower multiple pregnancies. Multiple follicles development can increase clinical pregnancy rate, but also increase risk of multiple pregnancies. In addition,twice IUI cannot increase clinical pregnancy rate.