- PDF Free Download

Size: px

Start display at page:

Download "2 3 4 5 22 22 23 25 35 38 39 45 46 1"

甭报常
7 years ago
Views:

1 O O

3 intrauterine insemination IUI 202 IUI a 24 IUI b 24 IUI c hcg 36 IUI d hcg IUI % 11.5% a %, 11.3% b %, 2.22% c % 17.4% d %, 20.0%

14.9% 11.5% a 122 151 13.9%, 11.3% b 42 46 2.38%, 2.

4 Abstract As one of assisted reproductive techniques widely used, intrauterine insemination (IUI) has advantages of little cost, simple and convenient handling, little pain for patients and few complications. At present it has been the first-line therapy for infertility. The outcome of IUI is affected by age of patient, ovarian function, timing and frequency of insemination, number of follicles, endometrium and sperm quality. We make a retrospective study of 202 infertile couples with 262 cycles of IUI. 202 couples were divided into 4 groups: group A: IUI was performed within 24 hours after ovulation; group B: IUI was performed within 24 hours before ovulation; group C: IUI was performed once at 36 hours after hcg administration with controlled ovarian hyperstimulation; group D: IUI was performed twice, one at 24 hours after hcg administration, the other at 48 hours after hcg administration with controlled ovarian hyperstimulation. We compared pregnancy rates of 4 groups statistically to evaluate the influence of timing, frequency and number of follicles on pregnancy rate. In 202 couples with 262 cycles of IUI, 30 patients have pregnancy, two of them met with early abortion, one of them met with ectopic pregnancy and one of them has twin pregnancy. Pregnancy rate per cycle was 11.5%, pregnancy rate per couple was 14.9%. Pregnancy rate per cycle was 11.3% in group A and was 2.22% in group B, which was a statistically insignificant difference (p=0.07); pregnancy rate per cycle was 17.4% in group C and was 20.0% in group D, which was a statistically insignificant difference (p=1.00); pregnancy rate per cycle was 39.1% in patients which had at least 2 follicles and was 8.8% in patients which had one follicle, which was a statistically significant difference (p<0.05). We concluded: IUI performed within 24 hours after ovulation has more chance of pregnancy comparing with IUI performed within 24 hours before ovulation; there is no significant difference between single IUI and double IUI; the pregnancy rate of IUI can be increased with multiple follicles. Key words: intrauterine insemination, timing of insemination, frequency of insemination 3

The outcome of IUI is affected by age of patient, ovarian function, timing and frequency of insemination, number of follicles, endometrium and sperm quality.

5 AIH artificial insemination by husband AID artificial insemination by donor IUI intrauterine insemination AsAb antisperm antibody E 2 estradiol FSH follicle stimulating hormone LH luteinizing hormone BBT basal body temperature CC clomiphene citrate GnRH gonadotropic hormone releasing hormone LUFS luteinized unruptured follicle syndrome hmg human menopausal gonadotropin hcg human chorionic gonadotropin OHSS ovarian hyperstimulation syndrome IVF-ET in vitro fertilization and embryo transfer - ICSI intracytoplasmic sperm injection 4

hormone releasing hormone LUFS luteinized unruptured follicle syndrome hmg human menopausal gonadotropin hcg human chorionic

6 ar- tificial insemination by husband AIH artificial insemination by donor AID [1] (Intrauterine insemination, IUI) [2 3] : 1. < /ml a <25% a + b<50% >30% IUI [4] IUI IUI /ml IUI < /ml < /ml IUI [5-7]

7 2 antisperm antibody, AsAb AsAb AsAb AsAb AsAb AsAb IUI Grigoriou [9] IUI 6.5% 16.13% 9.21% 21.2% Robinson [8] 30 IUI 39.4% 4.8% 3. IUI 4. IUI IUI [10,11] Mohamed [12] IUI IUI IVF-ET 1. 1 B B 5mm 6

8 6 7 14mm 1.3mm 0.5mm 26mm 19.79mm 4.87mm 12.56mm 2.88mm 40%-50% 1 2 [1] 2 Insler score, 1 [1] 1 Insler ,,, 1/3 1/2,,

9 3 LH estradiol E 2 FSH LH FSH FSH E 2 LH E 2 LH FSH LH camp LH LH LH LH LH LH 6 12 LH LH LH 40IU/L LH, 40IU/L LH LH 20 4 : basal body temperature BBT : <9 < LUFS IUI IUI 2 8

40IU/L LH 24 36 LH 20 4 : basal body temperature BBT

10 (1) clomiphene citrate CC gonadotropic hormone releasing hormone GnRH FSH LH CC LUFS 10% 31% CC CC CC 50mg/ B mg CC LUFS hcg (2) human menopausal gonadotropin hmg 75IU FSH 75IU LH hcg hmg/hcg B hcg hcg IUI (3) CC/hMG/hCG hmg 3 7 CC100mg/ hmg 1 2 / B >18mm hcg IUI LH ovarian hyperstimulation syndrome OHSS, OHSS 9

75IU FSH 75IU LH hcg hmg/hcg 3 5 1 2 B hcg hcg 36 38 IUI (3) CC/hMG/hCG hmg 3 7

11 10 20% 2% hmg OHSS CC [1] CC/hMG/hCG OHSS 3 : 1 2 IUI Carrell [13] 363 IUI 5 Percoll 13.2% 12.7% Dodson WC [14] IUI Percoll, 15% 15% 21%, 10

12 4 Tom Cat 0.3 1ml 1 30 [15] IUI 2cm 0.3ml IUI % hcg IUI [1 16] 4 B % 28% [1] IUI % 13.3% (17.6% 4.5% ) [16] IUI 3 CC/HCG CC/FSH/HCG % 11.8% CC/HCG 12.0% 34.6% CC/FSH/HCG 22.6% 60.3% [11] Haebe [17] % Guzick [18] IUI 3.8% CC IUI 8.3% hmg IUI 17.1% IUI % 11

5% ) [16] 2001 7 2002 6 195 IUI 3 CC/HCG 103 379 CC/FSH/HCG 58 164 34 55 7.3% 11.8% CC/HCG 12.

13 50% [1] 1 IUI Sahakyan [19] IUI IUI 40 IUI Dickey [20] > Spandorfer [21] 40 IUI IVF-ET >40 IUI IVF-ET Schwartz [22] <30 10% >35 6% % 1 IUI 2. IUI % 30 12

14 5 3 [1] [23] FSH LH 2 4 FSH [ ] Toner [25] IVF-ET 3 FSH<10mIu/ml 18% FSH>25mIu/ml 0% [28] 3 FSH CC 10 FSH 3 FSH [29,30] mm 19.79mm 4.87mm [1] FSH LH, IUI [10,11 14,33] Ghosh [34] 20mm mm RR=0.58,95%CI=0.35,0.97 ( >15mm) 2 Dickey [20] 3381 CC IUI 1 9.8% % p=0.008 OR=1.97 [19 35,36] IUI [11] CC/hCG CC/FSH/hCG 92.6% 94.5% 12% 22.6% 34.6% 13

87mm [1] FSH LH, IUI [10,11 14,33] Ghosh [34] 20mm 15 19.99mm RR=0.58,95%CI=0.35,0.

15 60.3% FSH CC CC FSH [16] CC hmg/hcg CC/hMG/hCG 6.8% 12.9% 12.1% hmg/hcg LUFS CC LH [33] CC/hMG/hCG CC/hCG % 2 IUI 4. [40-42] B A B C : 11.94mm 2.93mm, 12.56mm 2.88mm 7 14

16 11.44mm 3.5mm E 2, [1] >10mm [37] Hock [39] hcg 21% 8% p< mm [42] IUI 73% 27% p<0.05 >14mm <7mm 7 10mm 11 13mm 2 [39 42] CC hmg CC IUI B,, IUI 15

医学院系课程教案记录本

医学院系课程教案记录本医学院临床医学系妇产科学课程教案记录本课程名称妇产科教师及职称黄荷凤教授授课内容生殖内分泌相关疾病和计划生育学时数 3 学时授课方式理论授课学期 2007-2008 第二学期授课对象 04 级七年制临床医学教学目的 ( 教学大