论文部分内容阅读
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。
Objective To investigate the therapeutic effect of different ovulation induction programs in intrauterine insemination (IUI). Methods One hundred and ninety-three infertile patients with ovulation-concurrent IUI were divided into 5 groups: letrozole in group A; clomiphene in group B; leptin combined with urotropin (HMG) ; D group was clomiphene combined with HMG; E group was HMG; on the 8th day of menstrual cycle, the follicular development was monitored by ultrasound. When the dominant follicle ≥20 mm, or urine LH positive, intramuscular injection of human chorionic gonadotropin (HCG) 10000 IU, then IUI 24 ~ 36h; observed the number of mature follicles, endometrial thickness, ovulation rate , Pregnancy rate, multiple pregnancy rate, ovarian hyperstimulation syndrome (OHSS). Results Compared with group B, the number of mature follicle in HCG group in group C and group D was significantly higher than that in control group (P <0.05), and the thickness of endometrium in group E was higher than that in control group P <0.05). The ovulation rate was 96.8% in group C, 85.7% in group B, with no significant difference (P> 0.05). Pregnancy rate in group E was 25.0%, and in group B was 4.8%, the difference was not statistically significant (P > 0.05). There were 2 cases of twin pregnancy in group D, 1 case of twin pregnancy in group C, and 1 case of pregnancy in group A. C group OHSS cases occurred. Conclusions There is no significant difference in clinical pregnancy rates among various ovulation induction programs in IUI. HMG can promote the growth of follicles and endometrial development. Combined treatment can make up for the thinner intima caused by clomiphene alone, Increase clinical pregnancy rate; ovulation process should focus on controlling the number of dominant follicles, as much as possible to reduce the incidence of OHSS and multiple pregnancy.