【摘要】 目的比较单独使用促性腺激素释放激素激动剂(Gn RHa)与Gn RHa联合小剂量人绒毛膜促性腺激素(h CG)诱发排卵在多囊卵巢综合征(PCOS)患者促排卵后行夫精人工授精(AIH)的临床结局。方法回顾性分析125例促排卵后行AIH的PCOS患者,分别单独使用Gn RHa(Gn RHa组,61例)或使用Gn RHa联合小剂量h CG(Gn RHa+h CG组,64例)诱发排卵,比较两组患者的排卵个数、排卵率、排卵一周后血清雌二醇(E2)和黄体酮(P)水平、生化妊娠率、临床妊娠率、活产率以及未破裂卵泡黄素化综合征(LUFS)和卵巢过度刺激综合征(OHSS)发生情况。结果 (1)两组患者在年龄、不孕年限、不孕类型、BMI、基础血清促卵泡激素(FSH)、黄体生成素(LH)、催乳素(PRL)、E2、睾酮(T)水平的差异均无统计学意义(P>0.05);(2)两组患者在Gn使用量及使用天数、扳机日卵泡个数(≥14 mm)、扳机日E2、扳机日P、扳机日内膜厚度的差异均无统计学意义(P>0.05),但在扳机日LH水平有统计学差异(P<0.05);(3)两组患者在排卵个数、排卵率、LUFS发生率、黄体支持、排卵一周后血清E2及P水平、OHSS发生率上无统计学差异(P>0.05);(4)两组患者在生化妊娠率、流产率、活产率无统计学差异(P>0.05),但h CG+Gn RHa组临床妊娠率显著高于Gn RHa组(分别为25.0%和11.5%,P=0.05);(5)Gn RHa组中无一例双胎妊娠,但h CG+Gn RHa组中却有5例双胎妊娠。结论使用Gn RHa联合小剂量h CG诱发排卵可增加PCOS患者促排卵行AIH助孕的临床妊娠率,且未增加OHSS的发生风险。更多还原

【Abstract】 Objective To compare the clinical outcomes of using Gn RHa alone or combination of Gn RHa and h CG to induce follicular maturation in PCOS patients on ovulation induction. Methods Retrospectively analyzed 125 cases of PCOS patients performed AIH, using Gn RHa(Gn RHa group, 61 cases) alone or combination of Gn RHa and h CG(Gn RHa+h CG group, 64 cases) to induce follicular maturation, compared the two groups’ ovulation number, ovulation rate, serum E2 and P levels a week after ovulation, biochemical pregnancy rate, clinical pregnancy rate, live birth rate, and the incidence of OHSS and LUFS. Results There were no significant difference in age, duration of infertility, infertility type, BMI, baseserum FSH, LH, PRL, E2 and T levels in the two groups. The Gn dosage and days, number of follicles(≥14 mm), serum E2, P level and endometrial thickness differences at HCG day were not statistically significant in two groups except serum LH. The ovulation number, ovulation rate, serum E2 and P levels a week after ovulation, LUF and OHSS incidence in two groups were no significant difference on the rate. There were no significant difference in biochemical pregnancy rate, miscarriage rate, live birth rates in two groups of patients, but GnR Ha+h CG group’s clinical pregnancy rate was significantly higher than GnR Ha group(25.0% and 11.5%, respectively, P=0.05). We also found that there were five cases of twin pregnancies in GnR Ha+hC G group, but no case of twin pregnancy in GnR Ha group. Conclusion Dual trigger with combination of gonadotropin-releasing hormone agonist and low-dose human chorionic gonadotropin could optimize clinical pregnancy rates in PCOS patients undergoing AIH, and did not increase the risk of OHSS.更多还原