不明原因不孕夫妇行IVF-ET时机的探讨

目的 :探讨对不明原因不孕妇女进行辅助生殖技术的最佳时机及方法。方法 :将 2 5 6例不明原因的不孕妇女分成 A、 B、C3组 ,A组为经历 1～ 3个 COH/ IUI周期的妇女 2 5 6人 ,共 475周期。B组为经历第 4、第 5、第6 COH/ IUI周期的妇女 41人 ,共 74周期。C组为经历前 3个 COH/ IUI周期失败后 ,进行 IVF和 ICSI治疗 1周期的5 9人。结果 :A组 75人获得妊娠 ,平均每周期妊娠率为 15 .8%,累积妊娠率为 2 9.2 %。B组 4人获得妊娠 ,平均每周期的妊娠率为 5 .4%,累积妊娠率为 38.9%,与 A组相比妊娠率明显降低 ,有统计学上的差异 ( P<0 .0 5 ) ,进一步增加的妊娠率为 9.7%。C组 2 2人获得妊娠 ,妊娠率为 37.2 %,明显高于 B组 ,有统计学上的差异 ( P<0 .0 1)。结论 :对于原因不明的妇女首先应进行 COH/ IUI周期治疗 ,当 3周期 COH/ IU I失败后 ,应进行 IVF和 ICSI治疗。

Discuss the optimum time and method of invitro fertilization embryo transfer in unexplained infertility

Objective: To investigate the optimum time and method of the assisted reproductive techniques in unexplained infertility. Method: 256 unexplained infertilities couples were classified into three groups. One to three cycles of controlled ovarian hyper stimulation (COH)/intrauterine insemination (IUI) were performed in 256 patients (group A) undergoing 475 cycles. Up to three further trial (cycles 4～6) of COH/IUI were then performed in 41 patients (group B) a total of 71 cycles. A historical comparison (group C) consisted of 59 patients with 3 failed cycles of COH/IUI who underwent 1 cycle of in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) at this center. Results: In group A 75 pregnancies occurred, with a cycle fecundity of 15 8% and accumulative pregnancy rate (PR) of 29 2% after the first 3 cycles. In group B 4 pregnancies occurred, with a cycle's fecundity of 5 4%. Significantly lower than that of group A ( P <0 05), the cumulative PR rose to 48 5% by cycles further increases of only 9 7%. In the women undergoing IVF and ICSI in group C, 22 pregnancies occurred, with a cycle fecundity of 37 2% per cycle, significantly higher than that of group B ( P <0 01). Conclusion: In unexplained infertility first performed COH/IUI. When they had not pregnancies after three cycles COH/IUI, they should undergo IVF and ICSI.