无排卵障碍人群行自然周期-IUI失败后不同用药方案对妊娠结局的影响  

Influence of the different ovulation protocols on the outcome of subsequent IUI cycle after failure of the first natural cycle in non-ovulatory dysfunction patients

作　　者：司沙沙[1] 孙玉红 李云 黎平[1] SI Shasha;SUN Yuhong;LI Yun;LI Ping(Reproductive Medicine Center, Jiangmen Central Hospital,Jiangmen 529030,Guangdong ,China)

机构地区：[1]广东省江门市中心医院生殖中心,广东江门529030

出　　处：《包头医学院学报》2020年第4期17-19,78,共4页Journal of Baotou Medical College

基　　金：江门市科技计划项目(201801002001035)。

摘　　要：目的:探讨分析自然周期-子宫腔内人工受精(NC-IUI)助孕失败后不同用药方案对后续IUI周期妊娠结局的影响。方法:纳入2015年1月至2020年1月因NC-IUI助孕失败的不孕女性,313人进入第2周期、237人进入第3周期,按照用药方案分为NC组和促排卵方案(COS)组,COS组按照用药不同分为来曲唑(LE)组、克罗米芬(CC)组、尿促性素(HMG)组、LE+HMG组、CC+HMG组,比较各组的临床资料及临床妊娠率。结果:6组临床资料差异无统计学意义(P>0.05),NC组临床妊娠率低于HMG组和COS组(均为P<0.05);第2周期IUI助孕中临床资料差异无统计学意义(P>0.05),6组妊娠率分别为7.04%、7.69%、8.33%、13.87%、13.89%、15.91%,有升高趋势但差异无统计学意义(P>0.05),NC组与COS组临床妊娠率差异无统计学意义(P>0.05);第3周期IUI助孕中临床资料差异无统计学意义(P>0.05),6组的临床妊娠率分别为2.86%、0.00%、0.00%、9.00%、4.17%、4.17%,差异无统计学意义(P>0.05);COS组临床妊娠率6.59%,与NC组比较差异无统计学意义(P>0.05)。结论:无排卵障碍患者行首次NC-IUI助孕失败后再次行NC方案仍可获得一定的临床妊娠率,但促排卵方案临床妊娠率更高,且以HMG、LE+HMG、CC+HMG临床妊娠率较高,推荐使用;此类人群在行IUI助孕2个周期均失败后再行IUI助孕的妊娠结局与用药方案关系甚微,可考虑更为积极的助孕手段。Objective:To explore and analyze the influence of different ovulation protocols on the pregnancy outcome of subsequent IUI cycles after the 1st failure of natural cycle-IUI(NC-IUI).Methods:The clinical data of infertile women who failed in the first NC-IUI cycle from January 2015 to January 2020,313 and 237 women were collected enrolled into the 2nd and 3rd cycle respectively,which was divided into NC group,LE group,CC group,HMG group,LE+HMG group,CC+HMG group according to their ovulation protocol.Clinical data and clinical pregnancy rate of each group were compared.Results:Clinical data of the 6 groups had no statistical difference while the clinical pregnancy rate of the NC group was significantly lower than that of the HMG group and the COS group(P=0.03,P=0.04);there was no statistical difference in the clinical data of IUI assisted pregnancy in the 2nd cycle,the pregnancy rates of the 6 groups were 7.04%,7.69%,8.33%,13.87%,13.89%,and 15.91%,respectively,with an increasing trend but no statistical difference(P=0.67).There was no statistical difference in the clinical pregnancy rate between the NC group and COS group(7.04%vs 13.64%,P=0.14);clinical data in the 3rd cycle had no statistical difference.The clinical pregnancy rates of the 6 groups were 2.86%,0.00%,0.00%,9.00%,4.17%,4.17%,and none statistical difference(P=0.65);the clinical pregnancy rate in the COS group was 6.59%,which was not statistically different from the NC group(P=0.25).Conclusion:After the failure of the 1st NC-IUI cycle,some patients with anovulatory disorder can still get clinical pregnancy after the 2nd NC protocol,but patients undergoing controlled ovary stimulation(COS)have a higher clinical pregnancy rate.HMG protocol,LE+HMG protocol and CC+HMG protocol are recommended.After 2 IUI cycles failure,these infertile women have a very low clinical pregnancy rate in the 3rd IUI cycle.No matter what protocol is,more positive assisted techniques should be considered.

关 键 词：自然周期 宫腔内人工受精 促排卵 妊娠结局 

分 类 号：R71[医药卫生—妇产科学]