不同促排卵方案对不明原因不孕患者行宫腔内人工授精结局的比较

摘要

Objective:To compare the effects of different ovulation induction regimens on intrauterine insemination(IUI)outcomes in the patients with unexplained infertility.Methods:The clinical data of 1 280 cycles in 508 couples with less than 35 years oldtreated by IUI in the Reproductive and Genetic Center of the Suzhou Municipal Hospital from 2001 to 2015 were retrospective analyzed.According to whether the ovulation induction,the patients were divided into natural group(n=628 cycles)and ovulation induction group(n=652 cycles).The cycles in ovulation induction group were divided to 5 groups according to different ovulation regimens:clomiphene(CC) group (153 cycles),H MG group (126 cycles),letrozole (LE) group(132 cycles),CC+ HMG group(107 cycles),LE + HMG group (134 cycles).The clinical pregnancy rate,abortion rate,ectopic pregnancy rate and live birth rate were collected in the groups.The general data and the clinical outcome indicators were compared among the five groups.Results:The clinical pregnancy rate (12.73％ vs.8.76％)and live birth rate(10.43％ vs.7.48％)of ovulation induction combined with IUI group were significantly higher than those of natural cycle.The pregnancy rate and live birth rate of LE+HMG group (15.67％ and 14.93％),CC+HMG group(16.82％ and 13.08％)and HMG group (15.08 ％ and 14.29％)were significantly higher than those of LE group (8.33％ and 6.06 ％) and CC group(9.15％ and 5.88％)(P＜0.05),while LE+HMG group had more significantly lower abortion rate(4.76％),twins rate(4.76％) and ectopic pregnancy rate(0％) than the other groups(P＜0.05).Conclusions:Using letrozole and low dose of HMG for ovulation induction in IUI treatment for patients with unexplained infertility can obtain higher clinical pregnancy rate,lower multiple birth rate and abortion rate,which is the ideal program for the patients unexplained infertility with IUI treatment.%目的 比较不同促排卯方案对不明原因不孕患者行宫腔内人工授精(IUI)结局的影响. 方法 回顾性分析2010年1月至2015年12月在我院本部生殖与遗传中心就诊、年龄＜35岁、因“不明原因不孕”行IUI治疗的508对夫妇(共1 280个周期)的临床资料.按是否促排分为自然周期组(628个周期)和促排周期组(652个周期);促排周期又按促排方案不同分为:克罗米芬(CC)组153个周期,CC+尿促性腺素(HMG)组107个周期,HMG组126个周期,来曲唑(LE)组132个周期,LE+HMG组134个周期.比较各组患者的一般资料及临床妊娠率、流产率、异位妊娠率、活产率等指标. 结果 促排卵联合IUI治疗的临床妊娠率(12.73％ vs.8.76％)及活产率(10.43％ vs.7.48％)均显著高于自然周期组(P＜0.05);不同促排卵方案中,LE+HMG组、CC+ HMG组及HMG组的临床妊娠率和活产率显著高于LE组和CC组(P＜0.05);其中 LE+ HMG组有相对更低的流产率(4.76％)、双胎率(4.76％)及宫外孕率(0％),显著低于其他方案组(P＜0.结论 LE联合小剂量HMG促排卵后行IUI治疗,对于不明原因不孕症患者而言,具有更高的临床妊娠率,较低的多胎率、流产率,是较为理想安全的IUI治疗方案.