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。

Comparison of clinical effects of different ovulation induction in intrauterine artificial insemination

Objective：To discuss clinical effects of different ovulation induction in intrauterine artificial insemination.Methods：Infertile patients of 163 cycles of 109 cases received ovulation induction and IUI were included.A group of letrozole;B group clomiphene;C group,letrozole joint HMG;D group clomiphene joint HMG;E group HMG;When the dominant follicle ≥ 20 mm,or urinary LH（＋）,intramuscular injection of human chorionic gonadotropin（HCG） 10000 IU,after 24 ～ 36 h for IUI;observation of the use of HMG total number of mature follicles,endometrial thickness,ovulation rate,pregnancy rate,Multiple pregnancy rate Ovarian hyperstimulation syndrome（OHSS）.Results：Compared with B group,C group,the number of mature follicles injected with hCG day of D group higher than the control group,the difference was statistically significant（P0.05）;endometrial thickness of E group higher than the control group,the difference was statistically significant（P0.05）.Ovulation rate of C group was the highest and 96.8%;B group was lowest and 85.7%,the difference was not statistically significant（P 0.05）;pregnancy rate of E group was the highest and 25.0%;B group was lowest and 4.8% the difference was not statistically significant（P 0.05）;D group twin pregnancy occurred in 2 cases,C group 1 case of twin pregnancy occurred,A group of four pregnancies occurred in 1 case.C group occurred OHSS1 cases.Conclusions：Clinical pregnancy rate in IUI obtained from different ovulation induction was no significant difference;HMG can promote multiple follicular growth and endometrial development,combination therapy can be used to make up for disadvantages such as thin endometrial resulted from clomiphene and increased clinical pregnancy rate;the number of dominant follicle must be focused on during ovulation induction and to minimize the occurrence of OHSS and multiple pregnancies as far as possible.