不同促排卵方案联合宫腔内人工授精疗效分析

目的比较不同促排卵方案联合宫腔内人工授精（intrauterine insemination,IUI）治疗不孕症的疗效。方法对204例不孕症患者371个周期行IUI治疗,随机分为4组：自然周期（natural cycle,NC）组共102个周期,克罗米酚（Clomiphene,CC）组98个周期,人绝经期促性腺激素（human menopausal gonadotropin,HMG）/人绒毛膜促性腺激素（human chorionic gonadotropin,HCG）（HMG/HCG）组120个周期,CC/HMG/HCG组51个周期,比较不同促排卵方案的治疗效果。结果CC/HMG/HCG组（19.6%）与HMG/HCG组（20.0%）的周期妊娠率显著高于NC组（6.9%）及CC组（8.2%）（P〈0.01）。CC/HIMG/HCG组的HMG用药量和用药天数显著小于HMG/HCG组（P〈0.05）。结论CC/HMG/HCG和HMG/HCG促排卵联合IUI均能提高IUI治疗不孕症的妊娠率,CC/HMG/HCG促排卵药费支出少,更具有优势。     

不同授精方法与人工授精妊娠成功率的相关研究

目的探讨影响夫精宫腔内人工授精（IUI）临床妊娠率的各种因素。方法558对不孕夫妇采用不同促排卵方式和授精时间进行宫腔内人工授精（IUI）,同时B超监测子宫内膜厚度。结果共进行了623个周期治疗,周期妊娠成功率为13.3%。授精时子宫内膜的平均厚度为9.70±2.29mm。使用药物促排卵患者中,克罗米芬组（CC）组、尿促性腺组（HMG）组和CC＋HMG组的IUI成功率分别为28.2%、5.2%和25.0%,HMG组与CC组及CC＋HMG组相比差异显著（P分别等于0.000及0.001）。单次或双次IUI的成功率分别为10.9%和14.4%,二者之间无显著性差异（P=0.256）。Logistic回归结果显示：年龄、是否为自然周期排卵、以何种药物进行促排卵以及子宫内膜厚度是影响IUI成功的危险因素。利用ROC曲线对最佳操作点进行判定,结果发现子宫内膜厚度大于10.05mm时最容易成功妊娠。结论年轻、克罗米芬促排卵、子宫内膜厚度大于10.05mm者IUI容易成功。单次或排卵前后双次IUI与妊娠成功率无关。     

CC—HMG—HCG结合人工授精治疗不孕症初探

本文作者对92例原发不孕或继发不孕有排卵障碍的患者,应用CC－HMG－HCG促排卵治疗,采用个体化治疗方案,并采用丈夫精子进行宫腔内人工授精（AIH／IUI）治疗妊娠49例（49／92）,妊娠率为53．26％,治疗总周期为129周期,周期妊娠率为37．98％（49／129）,结论：CC－HMG－HCG促排卵及人工授精是治疗不孕的有效方法之一。     

不同排卵方案宫腔内人工授精临床结局分析

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(P0.05);CC组临床妊娠率、流产率低于CC+HMG组(P0.05),CC组临床妊娠率、继续妊娠率低于LE+HMG组(P0.05)。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。     

促排卵在人工授精治疗不孕症中的应用

目的　比较不同的促排卵方法联合宫腔内人工授精 (IUI)治疗不孕症的疗效。方法　以 2 0 0 1年 7月～ 2 0 0 2年6月间在我院不孕专科就诊的 195对夫妇作为观察对象 ,分为 3组 :CC/HCG组 ,共 10 3例 ,379个周期 ;CC/FSH/HCG组共 5 8例 ,16 4个周期 ;自然周期对照组 ,共 34例 ,5 5个周期。结果　自然周期对照组的周期妊娠率为 7 3% ,病例妊娠率为 11 8%。CC/HCG组的周期妊娠率为 12 0 % ,与对照组相比没有显著性差异 (P >0 0 5 ) ,与CC/FSH/HCG组相比有显著性差异 (P <0 0 1) ;病例妊娠率为 34 6 % ,与对照组相比有显著性差异 (P <0 0 1) ,与CC/FSH/HCG组相比有显著性差异 (P <0 0 5 )。CC/FSH/HCG组周期妊娠率为 2 2 6 % ,与对照组相比有显著性差异 (P <0 0 5 ) ;病例妊娠率为 6 0 3% ,与对照组相比也有显著性差异 (P <0 0 1)。结论　采用CC/HCG或CC/FSH/HCG促排卵可提高IUI治疗不孕症的妊娠率。     

宫腔内人工授精的临床应用

本文报道1采用丈夫精子进行宫腔内人工授精(AIH／IUI)治疗其他方法治疗无效的不平症38例，妊娘8例(8／38)，妊娠丰为21.05％,治疗总周期为69周期。罔期妊娠率为11．5％(8／69)，其中自然周期妊娠率为11．1%(2／8)。克罗米芬 hCG诱发排卵周期妊娠丰为11．7％(6／51）。     

自然周期和促排卵周期宫腔内人工授精临床分析

目的：对我中心2006年1月-2007年12月实施宫腔内人工授精（IUI）助孕的1073个周期进行临床分析。方法根据是否使用促排卵药物分为自然周期组和促排卵组,促排卵组又根据不同用药分组,比较各组临床妊娠率、自然流产率、多胎妊娠率和卵巢过度刺激综合征（OHSS）的发生率。结果自然周期组妊娠率低于促排卵组,分别为8.6%和20.0%,统计学分析有显著性差异（P〈0.01）。促排卵组中FSH组妊娠率最高,为45.5%,尿促性腺组（HMG）、克罗米芬（CC）＋HMG组和来曲唑＋HMG组妊娠率相似,分别为22.0%、18.8%和20.0%,三者比较无差异,但三者明显高于CC组或来曲唑组（13.9%和10.6%）（P〈0.01）。自然周期组无自然流产、多胎妊娠和OHSS的发生,促排卵组流产率13.9%,多胎妊娠率19.2%,OHSS发生率0.5%,40例多胎妊娠中35例和5例OHSS均发生于HMG组。结论促排卵组IUI妊娠率高于自然周期组,但促排卵增加多胎妊娠、流产和OHSS的发生;促排卵组中FSH、CC＋HMG或来曲唑＋HMG在保证较高妊娠率的同时,相对减少多胎妊娠和OHSS的发生。     

来曲唑联合小剂量尿促性素在不明原因不孕患者行夫精宫腔内人工授精中的临床疗效

目的评价来曲唑联合小剂量尿促性素(LE+HMG)促排卵方案对不明原因不孕患者行夫精宫腔内人工授精(AIH)结局的影响。方法采用病例对照研究将2014年1月至2017年12月在秦皇岛市妇幼保健院生殖医学科,年龄不超过38岁,因不明原因不孕行AIH治疗,共580对夫妇(1191个周期)的病例资料按是否促排分为6组,包括自然周期组512个周期、单纯克罗米芬促排(CC)131个周期,单纯HMG促排126个周期,CC+HMG促排148个周期,单纯LE促排133个周期,LE+HMG促排141个周期。比较各组患者的临床妊娠结局。结果促排卵联合AIH治疗的临床妊娠率(%/%)均显著高于自然周期组(p);5种促排卵方案里,不同促排卵方案中,临床妊娠率和活产率LE+HMG组显著高于单纯LE组和CC组(P0.05),而与CC+HMG组及HMG组相比,差异不明显(P0.05);其中HMG组双胎率相对最高(%),LE+HMG组的早期流产率(%)、双胎率(%)及宫外孕率(%),显著低于另4种方案组(P0.05)。结论对不明原因不孕患者行LE联合小剂量HMG促排卵+AIH治疗,可获得相对更高的临床妊娠率,较低的流产率和多胎率。     

夫精宫腔内人工授精治疗不孕症301例分析

目的探讨夫精宫腔内人工授精（IUI）的妊娠率及相关影响因素。方法精液采用混匀上游法,对301例不孕症患者进行IUI。结果301对夫妇,行435个周期的IUI治疗,共妊娠78个周期,累积妊娠率24.9%,周期妊娠率17.93%,其中2例发生宫外孕,葡萄胎2例,7例双胎或多胎,48例单胎,19个周期流产,其余孕期顺利。促排卵周期的妊娠率明显高于自然周期妊娠率,而3组促排卵方案的妊娠率无明显差异。注射HCG后授精时间4组的妊娠率无明显差异。结论IUI是一种有效的治疗不孕症的助孕技术,促排卵周期IUI妊娠率明显提高。     

雌二醇\雌二醇地屈孕酮应用于冻融胚胎移植周期子宫内膜准备的效果观察

目的观察雌二醇\雌二醇地屈孕酮应用于冻融胚胎移植(FET)周期子宫内膜准备的效果。方法回顾性分析2013年1月-2014年5月134例患者156个FET周期,根据内膜准备方案分为:自然周期组(66例),补佳乐人工周期组(43例),芬吗通人工周期组(47例),比较各组患者年龄、不孕年限、体重指数、用药剂量、转化日内膜厚度、平均移植胚胎个数、优质胚胎个数、冷冻胚胎复苏率、复苏后完整存活胚胎比率、生化妊娠率、胚胎种植率、临床妊娠率的差异。结果自然周期组内膜转化日内膜最厚(10.99±2.02mm),补佳乐组内膜最薄(8.86±1.59mm),差异有统计学意义(P0.05);芬吗通组(43.11±23.89mg)较补佳乐组(46.02±36.23mm)用药剂量少,差异有统计学意义(P0.05);三组患者年龄、不孕年限、体重指数、平均移植胚胎数、移植优质胚胎数、冷冻胚胎复苏率、复苏后完整存活胚胎比率、胚胎种植率、生化妊娠率及临床妊娠率比较无统计学意义(P0.05)。结论冻融胚胎移植中行人工周期内膜准备,使用芬吗通可以较少用药量获得与自然周期内膜准备及补佳乐人工周期准备相似的妊娠率。     

对小卵泡排卵不同助孕方式的相关研究

目的比较三种不同助孕方式用于小卵泡排卵性不孕患者的促排卵效果及妊娠结局,寻找一种更加安全高效的治疗方法。方法前瞻性分析301例小卵泡排卵患者的455个自然监排周期和459个促排卵助孕周期,根据患者输卵管情况及配偶精液结果,在病人知情同意条件下分为用药促排组、宫腔内夫精人工授精（AIH）组、体外受精-胚胎移植（IVF-ET）组。B超监测卵泡发育情况,并根据具体发育情况决定促排用药及剂量。比较三组间排卵日／HCG日优势卵泡（≥15mm）数、最大卵泡直径、Lufs发生率、OHSS发生率、周期妊娠率、异位妊娠率、多胎率及早期流产率。结果经以上助孕方式治疗后IVF-ET组的HCG日优势卵泡（≥15mm）数、周期妊娠率均高于其他两组,Lufs发生率低于其他组,差异均有统计学意义（P〈0．05）。IVF-ET组OHSS发生率及多胎率高于其他组,但差异无统计学意义（P〉0．05）。在用药促排组及AIH组中应用克罗米芬（CC）、尿促性素（HMG）、CC＋HMG的三种用药方案中,CC＋HMG周期妊娠率最高,差异有统计学意义（P〈0．05）;该用药早期流产率最低,差异无统计学意义（P〉0．05）。结论药物促排卵治疗对小卵泡排卵的患者有明显疗效;促排药物使用CC）联合HMG则有利于减轻CC的副作用,避免HMG引起的卵泡过小即排卵的情况,提高妊娠率,降低流产率;在药物促卵泡发育的同时,根据患者适应症采用辅助助孕技术AIH或IVF可进一步提高妊娠率,是小卵泡排卵较为安全有效的治疗方案。     

The value of GnRH analogue therapy in IVF in women with unexplained infertility

Seventy-six women with unexplained infertility, undergoing in-vitro fertilization and embryo transfer (IVF-embryo transfer), were selected for three different ovulation induction protocols. In group I, induction of ovulation was performed with pure follicle-stimulating hormone/human menopausal gonadotrophin/human chorionic gonadotrophin (pFSH/HMG/HCG). Group II patients were given a combined therapy consisting of a gonadotrophin-releasing hormone (GnRH) analogue, decapeptyl (DTRP6) followed by pFSH/HMG/HCG. In group III, patients underwent two IVF-embryo transfer cycles, serving as their own controls. The initial cycle was induced with pFSH/HMG/HCG while the second was stimulated using decapeptyl/pFSH/HMG/HCG. Significantly higher rates of fertilization, cleavage and pregnancy (P less than 0.001, P less than 0.07, P less than 0.001, respectively) were achieved in group II patients to whom combined GnRH agonists and gonadotrophins were given. Furthermore, among group III patients, no pregnancies occurred during the initial IVF-embryo transfer cycles whereas a 23% pregnancy rate (P less than 0.001) was obtained after GnRH agonist therapy. Our results indicate that the combination of GnRH agonists and gonadotrophins is of value in cases of unexplained infertility. Further, larger studies must be performed before the true efficacy of this mode of therapy can be determined in women with unexplained infertility.     

宫腔人工授精中不同促排卵方案的临床效果比较

目的探讨在宫腔人工受精（IUI）中不同促排卵方案的治疗效果。方法纳入促排卵并行IUI的不孕患者109例共163个周期,分为5组,A组为来曲唑;B组为氯米芬;C组为来曲唑联合尿促性素（HMG）;D组为氯米芬联合HMG;E组为HMG;月经周期第8天超声监测卵泡发育。当优势卵泡≥20 mm,或尿黄体生成素（LH）阳性,肌肉注射人绒毛膜促性腺激（HCG）10000 IU,之后24～36h进行IUI;观察成熟卵泡数、子宫内膜厚度、排卵率、妊娠率、多胎妊娠率、卵巢过度刺激综合征（OHSS）。结果与B组比较,C组,D组HCG日成熟卵泡数目高于对照组,差异有统计学意义（P〈0.05）;E组的子宫内膜厚度高于对照组,差异有统计学意义（P〈0.05）。排卵率C组最高为96.8%;B组最低为85.7%,差异无统计学意义（P〉0.05）;妊娠率E组为25.0%最高;B组为4.8%最低,差异无统计学意义（P〉0.05）;D组发生双胎妊娠2例,C组发生双胎妊娠1例,A组发生四胎妊娠1例。C组发生OHSS1例。结论在IUI中各种促排卵方案获得的临床妊娠率差异无统计学意义;HMG能促进多个卵泡生长及子宫内膜发育,联合用药可弥补单用氯米芬导致的内膜薄等缺点,增加临床妊娠率;促排卵过程中须重点控制优势卵泡数量,尽可能减少OHSS及多胎妊娠的发生。     

联合使用药物促卵泡发育及排卵在超声监测下的效果评价

目的在超声监测下观察使用中西药物促排卵前后卵泡发育及排卵的情况。评价药物效果。方法对2008年1月至2010年6月在我院妇产科门诊就诊不孕症210例患者进行常规用药前妇科检查及用药后卵泡发育及排卵监测,观察三个周期,观察有无优势卵泡、排卵率、妊娠率、卵泡黄素化及卵巢过度刺激综合征等情况。结果 210例不孕症患者经克罗米芬（CC）和尿促性素（HMG）促卵泡生长及绒促性素（HCG）促排卵,辅以中药和其他对症治疗药物,促排卵。据使用药物的不同,分成三组观察药物疗效,一组,cc组,二组,HMG组,三组,联合用药组。三组的优势卵泡率分别为46%,64%,94%;排卵率分别为30%,46%78%;受孕率分别为11%,28%,57%;无优势卵泡率分别为：34%,22%,5%。卵泡黄素化率分别为：14%,0.9%,0.1%;卵巢过度刺激率分别为：0.9%,0.4%,0%。结论 CC＋HMG＋HCG＋中药联合应用促排卵效果较好,而且大大减少了并发症的发生,因此cc＋HMG＋HCG＋中药是不孕患者安全有效的治疗方法,同时大大提高了受孕率,成为不孕症患者的首选。     

Comparison of HMG/HCG superovulation for AID with or without superactive GnRH agonist

New methods of ovulation induction have been discovered andperfected in recent years. Among others, gonadotrophin-releasinghormone (GnRH) agonists are being used increasingly in the treatmentof ovulatory infertility. In a prospective study, 24 women undergoingartificial insemination with donor sperm (AID) and facing failureof treatment because of ovulation disorders, were treated withhuman menopausal gonadotrophin/human chorionic gonadotrophin(HMG/HCG) superovulation with or without pituitary densensitizationusing a superactive luteinizing hormone-releasing hormone (LHRH)agonist, buserelin (BUS), Suprefact (Hoechst, Frankfurt a/Main,FRG). In 86 cycles stimulated with HMG/HCG no pregnancy occurred,whereas 12 pregnancies occurred in the same group of patientsafter a total of 43 BUS/HMG/HCG stimulation cycles. SuperactiveLHRH agonists have a definite place in the treatment of AIDpatients presenting with refractory ovulation disorders and/orluteal insufficiency.     

Endocrinology: Induction of pre-ovulatory gonadotrophin surge with gonadotrophin-releasing hormone agonist compared to pre-ovulatory injection of human chorionic gonadotrophins for ovulation induction in intrauterine insemination treatment cycles

The clinical outcome of intrauterine insemination (IUI) treatmentcycles employing a gonadotrophin-releasing hormone agonist [GnRHa,triptorelin (Decapeptyl)] or human chorionic gonadotrophin (HCG)for ovulation induction was compared. A group of 48 patientspresenting with amenorrhoea, oligomenorrhoea or unexplainedinfertility were all treated with human menopausal gonadotrophins(HMG) from day 5 of the cycle, on an individualized schedule.They were then randomly divided into two groups to receive eithera single s.c. injection of 0.1 mg triptorelin or a single i.m.injection of 10 000 IU HCG after follicular maturation. IUIwas performed 24 and 48 h following the injection. A transitoryincrease in serum luteinizing hormone and follicle stimulatinghormone concentrations was achieved following injection of GnRHa.A total of 24 patients received 72 treatment cycles with GnRHa,producing 11 conceptions (15.3%) and two abortions (18.2%),resulting in a term pregnancy rate of 13.6%. There were fourcases of grade 3–4 ovarian hyperstimulation syndrome (OHSS),two of which were conception cycles. In all, 24 patients underwent68 cycles treated with HCG, producing 18 conceptions (26.5%)and six abortions (33.3%), resulting in a term pregnancy rateof 19.0%. There were eight cycles of grade 3–4 OHSS, twoof which were conception cycles. These results show that ans.c. injection of a relatively low dose of GnRHa can be as effectiveas HCG in producing pregnancy in IUI treatment cycles.     

Early resort to ovarian stimulation improves the cost-effectiveness of a donor insemination programme.

Women undergoing donor insemination (DI) are usually regularly ovulating, therefore the role of ovulation induction in this modality of treatment has been controversial. Some recent studies reported higher pregnancy rates in stimulated cycles in comparison with natural cycles. We employed a sequential step-up protocol in which treatment was started in a natural cycle, continued with a clomiphene citrate-stimulated cycle, and finished with an ovulation induction cycle. The patients were allowed three attempts at each step before moving to the next if conception did not occur. The aim of this protocol was to enhance the cost-effectiveness of the DI programme by increasing the cycle fecundability. A total of 101 patients underwent 216 cycles of DI, including 44 patients in 80 natural cycles, 38 patients in 89 CC-stimulated cycles, and 19 patients in 47 ovulation induction cycles. The clinical pregnancy rate per started cycle (CPR/C) and per patient during this period was 14% and 30% respectively. The pregnancy rates per started cycle and per patient in the natural, CC-stimulated and ovulation induction cycles were: 13 and 32%, 10 and 18%, and 21 and 53% respectively. There was no significant difference in the CPR/C in the three groups; however, the CPR per patient in the induced ovulation cycles was significantly higher than in the CC-stimulated cycles (P = 0.005). Only one patient during this period had a multiple pregnancy in the ovulation induction group, giving an overall multiple pregnancy of 3%. By using this treatment strategy, we achieved a high clinical pregnancy rate, a low multiple pregnancy rate and a low cost of treatment per pregnancy.