不孕及反复自然流产患者小卵泡排卵的诊治意义

Diagnostic and therapeutic significance of small follicular ovulation in infertile women and recurrent spontaneous abortion patients

目的 :探讨不孕及自然流产患者小卵泡排卵的临床意义及治疗方法。方法 :回顾性分析 10 3例阴道B超监测为小卵泡排卵的不孕及自然流产患者的临床特征 ,并给予单纯黄体支持及促排卵治疗 ,比较两种治疗方法的妊娠结局。结果 :10 3例小卵泡排卵的患者中不孕患者 74例 ,习惯性流产患者 4 9例 ,其中 2 0例同时有两种主诉。74例不孕患者中黄体功能不全的发生率为 5 9.5 % ,3 0例 (40 .5 % )诊断为不明原因不孕 ,而有自然流产史的患者黄体功能不全的发生率为 5 8.1% (18/ 3 1)。不孕患者中 4 6例接受 5 4个周期的单纯黄体支持治疗 ,2 9例接受 5 1个周期的促排卵治疗 ,妊娠率分别为 10 .9% (5 / 4 6)及 3 1.0 % (9/ 2 9) ,P =0 .0 3 7;活产率分别为 2 .2 % (1/ 4 6)及2 7.6% (8/ 2 9) ,P =0 .0 0 2 ;自然流产发生率分别为 80 .0 % (4/ 5 )及 11.1% (1/ 9) ,P =0 .0 2 3。人绒毛膜促性腺激素注射日卵泡径线≥ 18mm组周期妊娠率为 2 8.6% (14 / 4 9) ,高于 <18mm组的 6.6% (4/ 62 ) ,P =0 .0 0 3 ;而自然流产率分别为 14 .3 % (2 / 14 )及 75 .0 % (3 / 4 ) ,P =0 .0 19。结论 :小卵泡排卵是引起不孕及自然流产的原因之一 ,只有约一半的患者表现为黄体功能不全 ,因此B超监测是诊断小卵泡发育的主要方法。

Objective: To investigate the clinical significance and therapeutic efficacy of small follicular ovulation (SFO) in infertile women and recurrent spontaneous abortion patients. Methods: The clinic features of 103 infertile women and recurrent spontaneous abortion patients with SFO detected by transvaginal B ultrasonography were retrospectively analyzed. Luteal support alone in natural cycles and ovulation induction were used for treatment, and the pregnant outcomes were compared. Results:Among the 103 cases there were 74 infertile patients and 49 recurrent spontaneous abortion patients, of whom 20 had both complaints meanwhile. In the 74 infertile patients 31 were diagnosed as LPD (59.5%) and 30 as unexplained infertility(40.5%). The incidence of LPD was 58.1% (18/31) in the recurrent spontaneous abortion patients. The pregnant rate of both nature and induced ovulation cycles were 10.9%(5/46)and 31.0%(9/29)( P =0.037) respectively in infertile patients, live birth rates were 2.2%(1/46)and 27.6%(8/29)respectively (P =0.002) , spontaneous abortion rates 80.0% (4/5)and 11.1% (1/9)respectively ( P =0.023). The pregnant rate was 28.6%(14/49)in the group of the diameter of follicle ≥18 mm on HCG injection day, higher than that in the <18 mm group (6.6%, 4/62)( P =0.003). Spontaneous abortion rates were 14.3%(2/14)and 75.0% (3/4) respectively, P =0.019. Conclusion: SFO may be the cause of infertility and spontaneous abortion. Because only about half patients were diagnosed as LPD, B ultrasonography is the main method for diagnosis of SFO and we strongly suggest that B ultrasonography should be a routine examination for unexplained infertility and recurrent spontaneous abortion patients. Pregnant rate is lower and spontaneous abortion rate is higher in the patient with SFO. Induced ovulation treatment can increase the pregnant rate and improve the pregnant outcome.