不同促排卵方案联合宫腔内人工授精对多囊卵巢综合征所致不孕患者子宫内膜厚度、妊娠结局的影响

The Effect of Different Ovulation Induction Programs Combined with Intrauterine Insemination on the Endometrial Thickness and Pregnancy Outcome of Infertility Patients Caused by Polycystic Ovary Syndrome

目的:探讨不同促排卵方案联合宫腔内人工授精(IUI)对多囊卵巢综合征(PCOS)所致不孕患者子宫内膜厚度、妊娠结局的影响。方法:选取2018年1月-2019年1月佳木斯市妇幼保健院收治的120例PCOS致不孕患者,按照随机数字表法分为枸橼酸氯米芬(CC)组与来曲唑(LE)组,每组60例。分别采用枸橼酸氯米芬、来曲唑促排卵,并行IUI术。比较两组的卵泡发育情况、性激素[促卵泡激素(FSH)、黄体生成素(LH)、雌激素(E_(2))、孕酮(P)]水平、子宫参数及妊娠结局。结果:促排卵治疗后,CC组排卵数、平均卵泡≥14 mm个数均多于LE组,卵泡发育成熟率低于LE组,差异均有统计学意义(P<0.05)。两组促排卵治疗之日到HCG日时间、未破裂卵泡黄素化综合征(LUFS)发生率比较,差异均无统计学意义(P>0.05)。两组HCG日血清FSH、LH、E_(2)、P水平比较,差异均无统计学意义(P>0.05)。LE组IUI日子宫内膜厚度高于CC组,HCG日子宫动脉PI、RI均低于CC组,差异均有统计学意义(P<0.05)。IUI日,两组子宫内膜厚度均高于治疗前,差异均有统计学意义(P<0.05)。两组HCG日的PI、RI均低于治疗前,差异均有统计学意义(P<0.05)。两组多胎妊娠、异位妊娠、流产率比较,差异均无统计学意义(P>0.05)。CC组的临床妊娠率低于LE组,差异有统计学意义(P<0.05)。结论:来曲唑促排卵治疗能增加PCOS致不孕患者子宫内膜厚度,提高子宫内膜容受性,来曲唑促排卵方案联合IUI能提高患者妊娠率,值得推广。

Objective:To investigate the effects of different ovulation induction programs combined with intrauterine insemination (IUI) on the endometrial thickness and pregnancy outcome of infertility patients with polycystic ovary syndrome (PCOS).Method:A total of 120 patients with infertility caused by PCOS admitted to Jiamusi Maternal and Child Health Hospital from January 2018 to January 2019 were selected,they were divided into Clomiphene Citrate (CC) group and Letrozole (LE) group according to random number table method,with 60 patients in each group.Clomiphene Citrate and Letrozole were used for ovulation induction,and IUI was performed.Follicular development,sex hormone[follicle-stimulating hormone (FSH),luteinizing hormone (LH),estrogen (E_(2)),progesterone (P)]levels,uterine parameters and pregnancy outcomes were compared between two groups.Result:After ovulation induction treatment,the number of ovulation and the number of average follicles ≥14 mm in the CC group were higher than those in the LE group,and the follicle maturation rate in the CC group was lower than that in the LE group,the differences were statistically significant (P<0.05).There were no significant differences in the time to HCG day of ovulation induction treatment and the incidence of luteinization unruptured follicle syndrome (LUFS) between the two groups (P>0.05).There were no significant differences in serum FSH,LH,E_(2)and P levels between the two groups on HCG day (P>0.05).The endometrial thickness in the LE group was higher than that in the CC group on IUI day,and the uterine artery PI and RI on HCG day in the LE group were lower than those in the CC group,the differences were statistically significant (P<0.05).On IUI day,endometrial thickness in both groups were higher than those before treatment,the differences were statistically significant (P<0.05).PI and RI on HCG day in both groups were lower than those before treatment,the differences were statistically significant (P<0.05).There were no significant differences in the rates of multiple pregnancy,ectopic pregnancy and abortion between two groups (P>0.05).The clinical pregnancy rate in the CC group was lower than that in the LE group,the difference was statistically significant (P<0.05).Conclusion:Letrozole ovulation induction therapy can increase the endometrial thickness and endometrial receptivity of infertility patients with PCOS,Letrozole ovulation induction program combined with IUI can increase the pregnancy rate,and it is worthy of promotion.