不同排卵方案宫腔内人工授精临床结局分析

Analysis of clinical outcome of intrauterine insemination treatment with different ovulation program

目的探讨不同排卵方案对宫腔内人工授精(IUI)临床结局的影响,以提高IUI的临床疗效。方法对洛阳市生殖医学研究所2010年1月至2015年5月到我中心行IUI治疗的不孕症患者共1253个周期行回顾性分析,依据不同排卵方案分组,自然周期组(NC组)425个周期,氯米芬组(CC组)157个周期,来曲唑组(LE组)60个周期,尿促性腺激素组(HMG组)260个周期,氯米芬+尿促性腺激素组(CC+HMG组)216个周期,来曲唑+尿促性腺激素组(LE+HMG组)135个周期,比较NC组和促排卵组以及不同促排卵组之间的一般情况、临床结局。结果促排卵组的临床妊娠率、流产率、继续妊娠率均高于NC组(P<0.05);CC组临床妊娠率、流产率低于CC+HMG组(P<0.05),CC组临床妊娠率、继续妊娠率低于LE+HMG组(P<0.05)。结论自然周期IUI安全性较高,排卵障碍患者行促排IUI是不错的选择,口服药物联合针剂促排可显著提高IUI治疗周期妊娠率,LE在促排卵治疗中疗效肯定,值得进一步推广使用,远期影响有待大样本量的研究。

Objective：To analyze the effect of different ovulation program on the outcome of intrauterine insemination treatment（IUI）,in order to improve clinical effect of IUI. Methods：A retrospective study was conducted in 1253 IUI cycles of Institute of Reproduction,Luoyang Women ﹠ Children′s Health Care Hospital. The cycles were divided into 6 groups by different ovulation program, including natural cycle（NC）group,clomiphene（CC）group,letrozole（LE）group,human menopausal gonadotrophin（HMG）group,CC＋HMG group and LE＋HMG group. The pregnancy rate between nature cycles and ovarian hyperstimulation cycles was compared. Results：The clinical pregnancy rate,abortion rate and continue pregnancy rate of natural cycle group were lower than stimulation cycle group（P〈0.05）. The clinical pregnancy rate and abortion rate of CC group were lower than CC＋HMG group（P〈0.05）. The clinical pregnancy rate and continue pregnancy rate of CC group were lower than LE＋HMG group（P〈0.05）. Conclusions：Natural cycle with IUI is safe. Ovulation combined with IUI is a good choice for patients with ovulation disorder;CC or LE combined with HMG can significantly improve pregnancy rate of IUI;the effect of LE in the treatment of ovulation induction is certain,and it is worthy of promotion in clinic,and more research is needed.