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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。
Objective To compare ovulation induction with low dose of human chorionic gonadotropin (hCG) in combination with Gn RHa and Gn RHa alone after ovulation induction in ovariectomized women with polycystic ovary syndrome (PCOS) (AIH) clinical outcome. Methods A total of 125 patients with PCOS who had AIH after ovulation induction were retrospectively analyzed. Ovulation was induced by using Gn RHa alone (Gn RHa group, 61 cases) or Gn RHa combined with low dose h CG (Gn RHa + h CG group, 64 cases) , The number of ovulation, ovulation rate, serum estradiol (E2) and progesterone (P) level, biochemical pregnancy rate, clinical pregnancy rate, live birth rate and unruptured follicular luteinizing syndrome LUFS) and ovarian hyperstimulation syndrome (OHSS). Results (1) There was no significant difference in age, duration of infertility, type of infertility, BMI, basal serum FSH, LH, PRL, E2 and testosterone (P> 0.05). (2) The amount of Gn and days of use, the number of follicles on trigger day (≥14 mm), the triggering day E2, the triggering day P, the triggering intima-media thickness (P <0.05); (3) The number of ovulation, ovulation rate, the incidence of LUFS, the corpus luteum support, There was no significant difference in the incidence of OHSS between the two groups (P> 0.05). (4) The biochemical pregnancy rate, abortion rate and live birth rate had no significant difference between the two groups (P> 0.05) However, the clinical pregnancy rate in h CG + Gn RHa group was significantly higher than that in Gn RHa group (25.0% and 11.5%, respectively, P = 0.05). (5) There was no twin pregnancy in Gn RHa group, There are 5 cases of twin pregnancy. Conclusions The use of Gn RHa combined with small dose of h CG to induce ovulation can increase the clinical pregnancy rate of AIH-assisted pregnancy induced by ovulation induction in PCOS patients without increasing the risk of OHSS.