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目的探讨不同促排卵方案用于多囊卵巢综合征(Polycystic ovary syndrome,PCOS)患者宫腔内人工授精(Intrauterine insemination,IUI)的临床疗效及成本效果分析。方法病例来源于2011年1月-2015年1月期间来该院生育技术科就医接受IUI不孕症患者90例,共145个治疗周期,按随机数字表法将纳入病例分为观察组和对照组,每组45例。对应随机数字偶数者为观察组(78个IUI周期),奇数者为对照组(67个IUI周期)。对照组进行自然周期排卵IUI,观察组采取促排卵方案进行IUI,并将其按照采取不同的促排卵方案分为3组,分别为克罗米酚(CC)组、来曲唑(LE)组及人类绝经期促性腺激素(HMG)组。比较两组患者的妊娠结局及观察组内的不同促排卵方案下患者的妊娠结局和成本效果。结果观察组患者的临床妊娠率及多胎人数明显高于对照组,差异均具有统计学意义(χ~2=5.203,P<0.05;χ~2=4.448,P<0.05),两组患者中发生流产及异位妊娠的人数比较,差异均无统计学意义(χ~2=1.172,P>0.05;χ~2=0.865,P>0.05);LE组的妊娠率明显高于CC组,差异具有统计学意义(χ~2=6.139,P<0.05),其余各促排卵方案之间的妊娠率、流产人数、异位妊娠、多胎情况比较,差异均无统计学意义(χ~2=0.789,P>0.05);LE组获得单位效果所需花费的成本最少,方案最优。结论促排卵周期IUI妊娠率明显高于自然周期IUI,且未明显增加流产及异位妊娠人数,CC促排卵效果好,花费少,值得在临床推广使用。
Objective To investigate the clinical efficacy and cost-effectiveness of different ovulation induction strategies for intrauterine insemination (IUI) in patients with polycystic ovary syndrome (PCOS). Methods From January 2011 to January 2015, 90 cases of IUI infertility were admitted to the Reproductive Technology Section of the hospital for a total of 145 treatment cycles. The cases were divided into observation group and control group according to random number table method Group, 45 cases in each group. The even numbers corresponding to the random number were the observation group (78 IUI cycles) and the odd ones were the control group (67 IUI cycles). The control group received spontaneous IUI, and the observation group took IUI for ovulation induction. The patients were divided into 3 groups according to different ovulation induction strategies: clomiphene (CC) group, letrozole (LE) group And human menopausal gonadotropin (HMG) group. The pregnancy outcomes of the two groups were compared and the pregnancy outcomes and cost-effectiveness of the patients under different ovulation induction programs were observed. Results The clinical pregnancy rate and the number of multiple births in the observation group were significantly higher than those in the control group (χ ~ 2 = 5.203, P <0.05; χ ~ 2 = 4.448, P <0.05) There was no significant difference between abortion and ectopic pregnancy (χ ~ 2 = 1.172, P> 0.05; χ ~ 2 = 0.865, P> 0.05). The pregnancy rate in LE group was significantly higher than that in CC group (Χ ~ 2 = 6.139, P <0.05). There was no significant difference in pregnancy rate, abortion number, ectopic pregnancy and multiple births between the other ovulation induction programs (χ ~ 2 = 0.789, P> 0.05). The LE group had the least cost of unit effect and the optimal scheme. Conclusion The IUI pregnancy rate in ovulation - promoting period was significantly higher than that in natural period, and did not significantly increase the number of miscarriage and ectopic pregnancy. The ovulation - promoting effect of CC was good and cost less, which deserved to be used clinically.