摘要
目的研究三种促排卵方案对原因不明性不孕患者的治疗效果,为优化选择促排卵治疗方案提供依据。方法将73例诊断为原因不明性不孕患者共101周期纳入研究分为三组,分别予克罗米酚(CC组)、克罗米酚加人绝经期促性腺激素(HMG)(CC+HMG组),以及人绝经期促性腺激素(HMG组)三种方案促排卵。采用阴道超声监测卵泡发育,并联合尿促黄体生成素(LH)和Insler宫颈黏液评分以确定HCG注射时间,肌注HCG后30～40h指导同房,在确定排卵后3d开始肌注黄体酮支持。结果三组在年龄、不孕年限、窦卵泡数及基础内分泌方面无统计学差异。CC组的卵泡期[(16.32±1.73)d]显著长于CC+HMG组[(15.3±1.49)d]和HMG组[(13.85±1.19)d](P<0.05);注射HCG日子宫内膜厚度为(7.44±0.96)mm,少于CC+HMG组[(9.15±0.85)mm]和HMG组[(9.52±1.36)mm];排卵个数为(1.84±0.86)个,少于CC+HMG组[(2.06±0.75)个]和HMG组[(2.48±0.68)个]。三组妊娠率分别为12.9%、24.24%和26.92%,CC+HMG组和HMG组妊娠率显著高于CC组,但两组间无统计学差异(P<0.05)。HMG组周期取消率最高,达18.75%。CC组1例、CC+HMG组1例、HMG组2例发生中度卵巢过度刺激综合征(OHSS)。双胎2例,均发生于HMG组。结论对原因不明性不孕患者进行促排卵治疗,采用CC+HMG方案促排卵治疗效果优于CC方案、与HMG方案无统计学差异,但周期取消率、OHSS及多胎发生风险低于HMG方案,推荐采用。
Objective To select optimal ovary stimulation protocol for patients with unexplained infertility(UI).MethodsSeventy three patients(101 cycles)with UI were subjected to three ovary stimulation protocols:clomiphene citrate(CC),CC+human menopausal gonadotropin(HMG),or HMG.Trans-vaginal B-ultrasonic scanning combined with urine LH detection and cervical mucus evaluation by Insler scoring system were used to determine appropriate time of HCG injection.Timed intercourse was recommended 30-40 h after HCG administration.The luteal phase was supplemented with progesterone intramuscularly.ResultsThere were no differences in demographic characteristics between groups.The follicular phase was significantly longer in CC group compared with CC+HMG and HMG group[(16.32±1.73)d vs.(15.3±1.49)d and(13.85±1.19)d,respectively].The endometrial thickness at the time of HCG administration was significantly higher in patients receiving CC+HMG[(9.15±0.85)mm]and HMG[(9.52±1.36)mm]when compared with that in CC group[(7.44±0.96)mm],so did with the number of ruptured follicles(2.06±0.75 and 2.48±0.68 vs.1.84±0.86,respectively,P<0.05).Pregnancy rates were significantly higher in CC+HMG and HMG group compared with that in CC group(24.24% and 26.92% vs.12.9%,respectively;P<0.05),but comparable between CC+HMG and HMG group.The cancellation rate of treatment cycles was highest in HMG group(18.75%).1 OHSS case occurred in CC group,1 in CC+HMG group and 2 in HMG group.Totally 2 twins occurred,both in HMG group.ConclusionsThe combined use of CC+HMG yielded a pregnancy rate higher than CC and comparable with HMG,and a lower cancellation rate and OHSS incidence compared with HMG group.CC+HMG may be regarded as the optimal selection for patients with UI receiving ovary stimulation protocol.
出处
《中华临床医师杂志（电子版）》
CAS
2011年第22期6627-6630,共4页
Chinese Journal of Clinicians(Electronic Edition)
