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目的观察经阴道小卵泡穿刺抽吸术后辅助宫腔内人工授精(IUI)治疗多囊卵巢综合症(PCOS)患者排卵障碍所致不孕的临床疗效,探讨其对PCOS患者内分泌及基础窦卵泡数的影响,并观察其在治疗后促排卵的反应性及妊娠情况。方法对于52例耐克罗米芬(CC)的PCOS患者于月经周期的第5天开始肌注HMG 75IU,连用5天后,行B超检查,经阴道抽吸两侧卵巢内小卵泡,保留1～3个相对较大的卵泡,继续应用HMG注射,当1～3个优势卵泡直径达18mm时,注射HCG诱发排卵,36h后行宫腔内人工授精.观察卵巢体积变化、排卵率、单卵泡排卵率、妊娠率、多胎、OHSS发生和周期取消例数。结果对52例患者进行了92个周期的穿刺治疗,2个穿刺周期后患者睾酮(T)和促黄体生成素/促卵泡激素(LH/FSH)比值均明显降低,与治疗前比较,差异有统计学意义(P<0.01),29例卵巢体积明显缩小,35例双卵巢内窦卵泡数降到10个以下,穿刺前后对比,差异有显著性(P<0.01)。92个穿刺周期中,83个周期排卵,排卵率达90.2%,其中单卵排卵率占68.4%(63/92),临床妊娠25例,妊娠率48%,无1例患者发生卵巢过度刺激综合征(OHSS)。结论对于CC耐药或对Gn反应不良的PCOS患者采用经阴道小卵泡抽吸术及辅助人工授精助孕的治疗方式可极大提高单卵泡排卵和单胎妊娠率,避免多胎和OHSS的发生。
Objective To observe the clinical efficacy of transvaginal follicular aspiration (IUI) assisted intrauterine insemination (IUI) in the treatment of infertility caused by ovulation disorders in patients with polycystic ovary syndrome (PCOS), and to explore the effect on the endocrine and basic antral follicles The number of effects, and observe its response to ovulation induction and pregnancy after treatment. Methods Fifty - two PCOS patients with nocomelin (CC) started intramuscular injection of HMI 75IU on the fifth day of the menstrual cycle. Five days later, B - mode ultrasonography was performed. All ovarian follicles on both sides were vaginal aspirated and 1 to 3 Relatively large follicles, continue to use HMG injection, when 1 to 3 dominant follicles diameter of 18mm, HCG-induced ovulation induction, intrauterine insemination 36h after intrauterine insemination observed changes in ovarian volume, ovulation rate, single ovulation rate, pregnancy Rate, multiple births, number of OHSS occurrences and cycles canceled. Results Totally 52 cycles of puncture were performed in 52 patients. The testosterone (T) and luteinizing hormone / follicle stimulating hormone (LH / FSH) ratio decreased significantly after 2 puncture cycles. Compared with those before treatment, the difference was Statistical significance (P <0.01), 29 cases of ovarian volume was significantly reduced, 35 cases of double ovarian follicles within the antral declination below 10 before and after puncture, the difference was significant (P <0.01). In 92 puncture cycles, ovulation rate was 90.2% in 83 cycles, of which ovulation rate was 68.4% (63/92), clinical pregnancy rate was 25% and pregnancy rate was 48%. No ovarian hyperstimulation syndrome occurred in 1 patient Sign (OHSS). Conclusion The treatment of PCOS patients with poor response to CC or poor response to Gn using vaginal follicle aspiration and assisted artificial insemination can greatly improve the single follicle ovulation and singleton pregnancy rate, to avoid multiple births and OHSS.