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目的探讨不同排卵方案对宫腔内人工授精(IUI)临床结局的影响,以提高IUI的临床疗效。方法对洛阳市生殖医学研究所2010年1月至2015年5月到我中心行IUI治疗的不孕症患者共1253个周期行回顾性分析,依据不同排卵方案分组,自然周期组(NC组)425个周期,氯米芬组(CC组)157个周期,来曲唑组(LE组)60个周期,尿促性腺激素组(HMG组)260个周期,氯米芬+尿促性腺激素组(CC+HMG组)216个周期,来曲唑+尿促性腺激素组(LE+HMG组)135个周期,比较NC组和促排卵组以及不同促排卵组之间的一般情况、临床结局。结果促排卵组的临床妊娠率、流产率、继续妊娠率均高于NC组(P<0.05);CC组临床妊娠率、流产率低于CC+HMG组(P<0.05),CC组临床妊娠率、继续妊娠率低于LE+HMG组(P<0.05)。结论自然周期IUI安全性较高,排卵障碍患者行促排IUI是不错的选择,口服药物联合针剂促排可显著提高IUI治疗周期妊娠率,LE在促排卵治疗中疗效肯定,值得进一步推广使用,远期影响有待大样本量的研究。
Objective To investigate the effect of different ovulation protocols on intrauterine insemination (IUI) clinical outcomes in order to improve the clinical efficacy of IUI. Methods A retrospective analysis of 1,253 infertility patients who underwent IUI treatment from January 2010 to May 2015 in Luoyang Reproductive Medicine Institute was conducted. According to different ovulation plans, the natural cycle group (NC group) 425 cycles, 157 cycles in clomiphene citrate group (CC group), 60 cycles in letrozole group (LE group), 260 cycles in urine gonadotropin group (HMG group), clomiphene citrate + (CC + HMG group) for 216 cycles and letrozole + urinary gonadotropin group (LE + HMG group) for 135 cycles. The general situation and clinical outcomes between NC group and ovulation induction group and different ovulation induction group were compared. Results The clinical pregnancy rate, miscarriage rate and continuous pregnancy rate in ovulation induction group were significantly higher than those in NC group (P <0.05). Clinical pregnancy rate and abortion rate in CC group were lower than those in CC + HMG group (P <0.05) Rate, the rate of continuing pregnancy was lower than that of LE + HMG group (P <0.05). Conclusions The natural period IUI is safe and IUI is the best choice for patients with ovulation disorder. Oral drug combined with injection can significantly improve the pregnancy rate of IUI. LE is effective in promoting ovulation and is worth further promotion. Long-term effects awaiting large sample size studies.