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目的:探讨宫腔内人工授精(IUI)的最佳促排卵方案。方法:回顾性分析646个IUI周期,比较自然周期与促排卵周期、不同优势卵泡数目的促排卵周期、不同促排卵方案之间患者的临床妊娠率、多胎率、流产率的差异。结果:1促排卵周期人工授精临床妊娠率显著高于自然周期(20.84%vs 8.77%,P<0.05);2 h CG注射日优势卵泡数目1个、2个、3个之间的促排卵周期临床妊娠率分别为13.6%、24.14%、32.35%,差异有统计学意义(P<0.01);3氯米芬(CC)与CC联合尿促性腺激素(CC+h MG)2种促排卵方案相比,CC+h MG组与CC组比较,h CG注射日优势卵泡数(2.0±0.9 vs 1.5±0.3)、子宫内膜厚度(9.41±1.88 mm vs 8.06±1.92 mm)、妊娠率(22.13%vs 10.93%)差异均有统计学意义(P<0.05);来曲唑(LE)与LE+h MG 2种促排卵方案相比,LE+h MG组优势卵泡数显著大于LE组(1.6±0.7 vs 1.0±0.0,P<0.01),且临床妊娠率有增高的趋势。结论:各种促排卵方案能增加IUI临床妊娠率,CC或LE联合小剂量h MG的温和促排卵方案,能获得一个最为理想的临床结局。
Objective: To investigate the best intrauterine insemination (IUI) ovulation promotion program. Methods: 646 IUI cycles were retrospectively analyzed. The differences of natural pregnancy cycle, ovulation cycle, ovulation cycle of different dominant follicles, clinical pregnancy rate, multiple pregnancy rate and miscarriage rate among different ovulation induction programs were compared. Results: The clinical pregnancy rate of ovulation induction was significantly higher than that of natural cycle (20.84% vs 8.77%, P <0.05). The numbers of dominant follicles at 1 h, 2 and 3 ovulation cycles The clinical pregnancy rates were 13.6%, 24.14% and 32.35%, respectively, with significant difference (P <0.01). The combination of clomiphene citrate (CC) and CC combined with CC + h MG Compared with CC group, the number of dominant follicles (2.0 ± 0.9 vs 1.5 ± 0.3), endometrial thickness (9.41 ± 1.88 mm vs 8.06 ± 1.92 mm), pregnancy rate (22.13 % vs 10.93%) (P <0.05). Compared with LE + h MG 2 kinds of ovulation induction programs, the number of dominant follicles in LE + h MG group was significantly higher than that in LE group (1.6 ± 0.7 vs 1.0 ± 0.0, P <0.01), and the clinical pregnancy rate increased. Conclusion: Various ovulation induction programs can increase the clinical pregnancy rate of IUI, moderate ovulation induction combined with small dose of MG or CC, and achieve a most ideal clinical outcome.