氯米芬联合HMG在促排卵人工授精周期中防止过早内源性黄体生成素峰的有效性研究

A study of clomiphene citrate in preventing premature LH surge during controlled ovarian stimulation in women undergoing IUI

目的:探讨氯米芬(CC)联合人绝经尿促性腺激素(HMG)在原因不明性不孕患者促排卵人工授精(COS/IUI)周期中防止过早内源性黄体生成素(LH)峰的有效性,为提高IUI妊娠率提供临床依据。方法:将2012年1月至2015年1月在我院生殖中心因原因不明性不孕行COS/IUI的144例患者随机分为观察组和对照组,每组72例。观察组给予CC+HMG方案促排卵,对照组单用HMG促排卵。观察两组的过早LH峰发生率、临床妊娠率、未破裂黄素化卵泡(LUF)发生率、周期取消率、卵巢过度刺激综合征(OHSS)发生率、多胎妊娠率,以及HCG注射日子宫内膜厚度、E2水平、成熟卵泡数。结果:观察组的过早LH峰发生率(5.8%)及LUF发生率(8.7%)显著低于对照组(17.9%、20.9%,P<0.05),E2水平[(379.4±127.8)pg/ml]、成熟卵泡数(2.43±0.75)、临床妊娠率(21.7%)均高于对照组[(288.8±97.3)pg/ml,1.71±0.78,9.0%](P<0.05);两组的周期取消率、子宫内膜厚度、OHSS发生率及多胎妊娠率比较,差异均无统计学意义。结论:原因不明性不孕患者COS/IUI过程中,CC+HMG促排卵方案可以有效防止过早内源性LH峰的发生,并提高IUI的临床妊娠率。

Objective：To study the effectiveness of clomiphene citrate combined with HMG in preventing premature LH surge during controlled ovarian stimulation in women undergoing IUI. To Provide the clinical basis for the improvement of IUI pregnancy rates. Methods： A total of 144 cases from Jan. 2012 to Jan. 2015 were randomly assigned either an observation group treated with CC＋HMG （n = 72） or a control group only treated with HMG controlled ovarian stimulation （ n = 72）. The premature LH rates, clinical pregnancy rates, LUF rates, canceled cycles rates, OHSS rates, multiple pregnancy rates, the day of HCG injection endometrial thickness, E2 levels, and the number of mature follicles were observed and compared： Results： Compared with the control group, the number of patients who had a premature LH surge and LUF was significantly lower in the observation group （5.8% vs 17.9% ,8.7% vs 20.9% ,P〈 0.05 ）. The mean E2 levels （pg/ml）, the number of mature follicles and the pregnancy rates were significantly higher[ （379.4±127.8） pg/ml vs （288.8±97.3） pg/ml , 2. 43 ±0. 75 vs 1.71±0.78,21.7% vs 9.0% ,P〈0.05 ）. There was no significant difference in cancellation, endometrial thickness, OHSS rates and multiple pregnancy rates. Conclusions： During the process of COS/IUI in unknown reason infertility, CC combined with HMG has been proven to be effective in reducing premature LH surges, and able to improve the pregnancy rates.