不同促排卵方案用于PCOS患者宫腔内人工授精的临床效果分析  

Clinical effects of different ovarian stimulation protocols for intrauterine insemination women with polycystic ovary syndrome

作　　者：罗小欢 夏薇[1] 苏宁[1] 王维[1] 曾艳华[1] 

机构地区：[1]广东省广州市第一人民医院生殖健康与不孕症专科,510180

出　　处：《中国计划生育学杂志》2015年第4期246-251,共6页Chinese Journal of Family Planning

摘　　要：目的:探讨不同促排卵药物及其配伍用于PCOS患者行宫腔内人工授精(IUI)的临床效果,筛选最优促排卵方案。方法:回顾性分析行PCOS患者IUI 634个周期,根据所采用的不同促排卵方案分成氯米芬(CC)组(84周期)、来曲唑(LE)组(76周期)、尿促性腺激素(HMG)组(153周期)、卵泡刺激素(FSH)组(45周期)、CC+HMG组(96周期)、CC+FSH组(75周期)、LE+HMG组(49周期)和LE+FSH组(56周期)等8组,比较各组患者的基本特征、卵泡发育情况、子宫内膜厚度、促性腺激素(Gn)使用天数及总用量、IUI结局和并发症发生率等。结果:Gn组(FSH组、HMG组)及CC联合药物组(CC+HMG组、CC+FSH组)的优势卵泡数和排卵数均多于单纯口服药物组(CC组、LE组)与LE联合药物组(LE+HMG组、LE+FSH组)(P<0.05);8组中以LE组的单卵泡发育成熟率(82.89%)最高(P<0.01);到达人绒毛膜促性腺激素(hCG)日天数HMG组、CC+HMG组、LE+HMG组均多于单纯口服药物组(CC组、LE组)(P<0.05);CC组手术日子宫内膜厚度及手术日子宫内膜厚度<8mm的比例低于其余各组(P<0.05);联合药物组(CC+HMG组、CC+FSH组、LE+HMG组和LE+FSH组)使用Gn的天数及总量均低于Gn组(P<0.05);临床妊娠率CC组最低(P<0.05),其余各组比较均无统计学差异(P>0.05);4例轻度卵巢过度刺激综合征(OHSS)均出现在Gn组,14例多胎妊娠出现在Gn组(11例)和联合药物组(3例)。结论:CC组妊娠率较低,可能与其抗雌激素作用影响子宫内膜厚度有关;LE组的单卵泡成熟率高,妊娠率满意;Gn组与联合药物组的临床妊娠率相当,但单独使用Gn伴随较高的OHSS发生率和多胎妊娠率,而联合促排方案则可明显减少Gn的使用天数及总使用量,减少OHSS的发生率和多胎妊娠率,因此,联合促排方案值得推广。Objective：To analyze clinical effects of different ovarian stimulation protocols among women with polycystic ovary syndrome undergoing intrauterine insemination（IUI）.Methods：A retrospective study was conducted to analyze634 IUI cycles for patients with PCOS from January 2010 to December 2013.According to different ovarian stimulation protocols,patients were divided into 8groups（CC,LE,HMG,FSH,CC＋HMG,CC＋FSH,LE＋HMG,LE＋FSH）.The essential characteristics,follicular development situation,endometrial thickness,duration and dose of gonadotropin（Gn）used,pregnancy outcomes and complications were evaluated among 8groups.Results：The total number of dominant follicles and the total number of ruptured follicles in Gn groups（FSH,HMG）and groups combined with CC（CC＋HMG,CC＋FSH）were significantly greater than those of simple oral drugs（CC,LE）and groups combined with LE（LE＋HMG,LE＋FSH,P〈0.05）.The rate of mono mature follicle in LE group was the highest（82.89%,P〈0.01）.The days to human chorionic gonadotropin（hCG）injection in HMG group,CC ＋ HMG group,LE ＋ HMG group were significantly greater than those of simple oral drug groups（P〈0.05）.Significant differences were found in the average thickness of endometrium and the number of endometrial thickness less than 8mm at IUI day between CC group and the remaining groups（P〈0.05）.The duration and dose of Gn used in combination groups（CC＋HMG,CC＋FSH,LE＋HMG and LE＋FSH）were significantly less than those of Gn groups（P〈0.05）.Clinical pregnancy rate of CC group was the lowest（P〈0.05）,and clinical pregnancy rates of the remaining groups had no significant differences（P〈0.05）.A total of 4cases of mild ovarian hyper-stimulation syndrome（OHSS）occurred in Gn groups and 14 cases of multiple pregnancy were found in Gn groups（n=11）and combination groups（n=3）.Conclusion：The clinical pregnancy rate of CC is the lowest that may be associated with the anti-estrogen effects which plays a rol

关 键 词：PCOS 促排卵 宫腔内人工授精 辅助生殖技术 妊娠结局 

分 类 号：R714.8[医药卫生—妇产科学]