子宫内膜异位症患者人工授精中促排卵周期与自然周期的比较

Comparison of ovulation induction cycle with natural cycle during intrauterine insemination in endometriosis patients

目的探索联合促排卵治疗是否能改善子宫内膜异位症相关不孕症患者腹腔镜术后行宫腔内人工授精(IUI)助孕的妊娠结局。方法回顾性分析2016年1月至2020年6月期间在宁波市第一医院生殖中心行IUI的子宫内膜异位症相关不孕症患者的临床资料,比较自然周期与促排卵周期的临床特征及妊娠结局的差异。结果共102例患者203个周期纳入研究,28例获得临床妊娠,周期临床妊娠率为13.79%,累积妊娠率为27.45%。自然周期(127个)与促排卵周期(76个)的周期临床妊娠率差异无统计学意义(14.17%vs.13.16%,χ^(2)=0.041,P>0.05)。自然周期扳机日的平均内膜厚度显著大于促排卵周期,(10.11±1.95)mm vs.(9.33±1.64)mm,t=2.943,P<0.05。克罗米芬/克罗米芬+促性腺激素(CC/CC+Gn)组、来曲唑/来曲唑+促性腺激素(LE/LE+Gn)组及促性腺激素(Gn)组的周期临床妊娠率分别为20.83%、10.53%、7.14%,但差异无统计学意义(χ^(2)=1.696,P>0.05)。结论子宫内膜异位症相关不孕症患者促排卵周期联合IUI相比于自然周期IUI并不能改善其妊娠结局。

Objective To explore whether combination of ovulation induction therapy could improve the pregnant outcomes of intrauterine insemination(IUI)in endometriosis-associated infertile patients after laparoscopic surgery.Methods Clinical data of endometriosis-associated infertile patients,who were treated with IUI from January 2016 to June 2020 in the Reproductive Medicine Centre,Ningbo First Hospital,was retrospectively analyzed.The differences of clinical features and pregnant outcomes between the natural cycle and ovulation induction cycle were compared.Results A total of 102 patients and 203 cycles were included in this study,and 28 patients got pregnant.The cyclic clinical pregnancy rate was 13.79%,and the cumulative clinical pregnancy rate was 27.45%.There was no significant difference in the cyclic clinical pregnancy rate between the natural cycle(127 cycles)and ovulation induction cycle(76 cycles)(14.17%vs.13.16%,χ^(2)=0.041,P>0.05).The endometrium of natural cycle on the trigger day was significantly thicker than that of ovulation induction cycle,(10.11±1.95)mm vs.(9.33±1.64)mm,t=2.943,P<0.05.Cyclic clinical pregnancy rates of the clomiphene/clomiphene+gonadotropin(CC/CC+Gn)group,letrozole/letrozole+gonadotropin(LE/LE+Gn)group and gonadotropin(Gn)group were 20.83%,10.53%and 7.14%,respectively,but with no significant difference(χ^(2)=1.696,P>0.05).Conclusion Compared with natural cycle combined with IUI,ovulation induction cycle combined with IUI in endometriosis-associated infertile patients could not improve pregnant outcomes.