| Objective:To explore the effectiveness of the PCOS infertility patients received IUI treatment,analysis the influence factors of its effectiveness and provide the basis for selecting reasonable treatment in order to short the treatment course and reduce patients'economic burden and improve the CPR.Methods:A retrospective analysis from January 2015 to March 2017 for PCOS patients in our reproductive center received IUI(AIH)and these people who failed with IUI go on to receive IVF/ICSI,until February 2018.Analysising the pregnancy outcome,basal state and efficiency of the treatment,thus got the relation of patients'characteristics(age,duration of infertility,BMI,basal endocrine state)with CPR.In order to avoid the effects of various factors mixed on CPR,the various conditions were screened and controlled to eliminate the extreme state,so as to minimize the interference of other factors in the study and to highlight the correlation between the factors and CPR.So we could find the key factors affecting CPR.The researches included:1.Studying the relationship between PCOS patients'age,duration of infertility,endocrine factors,different ovulation-inducing treatments,endometrial thickness of the trigger day of IUI;2.Compare the CPR of PCOS patients experienced each IUI;3.PCOS patients with who did not receive the clinical pregnancy in IUI continue to receive the IVF/ICSI,how many times and CPR they got;4.Selecting the infertile patients who received IUI because of asthenozoospermia and who received IVF/ICSI because of tubal obstruction in the same period as the control group at the same time.Results:The retrospective analysis above in PCOS patients 269 with a total of 413cycles,the number of people who failed to receive IUI change to received IVF/ICSI was83,including 105 cycles.There were 347 asthenozoospermia factor patients with IUI and 609 cycles.There were 307 tube factors patients with IVF/ICSI and 515 cycles.1.PCOS patients were grouped by controlling conditions,respectively analyzing the age,duration of infertility,BMI,the basic hormone FSH,LH,T,the rate of basic hormone LH/FSH,endometrial thickness of the trigger day,endometrial morphology of the trigger day,ovulation-inducing treatments of IUI.Control conditions included:in the age between 25 to 35 years old,infertility duration of ten years or less,BMI in(18~25)kg/m~2,T was less than or equal to 3nmol/L,endometrial thickness of the trigger day is(6~14)mm,endometrial morphology of the trigger day was A or B,stimulate ovulation solutions were divided into 3ways,oral pills,injection and oral pills+injection.When age factor was studied,There were significant differences in the age of(28.149±2.742)and(29.283±3.335)in the pregnancy group of PCOS pregnancy and not pregnancy group(p<0.05),the CPR of the age less than or equal to30 years old group and greater than 30 years old group was 29.01%and 14.75%,was statistically significant(P<0.05),and analysis asthenozoospermia factor group the CPR of the age less than or equal to 30 years old and greater than 30 years old was19.57%and 13.27%,had no statistical significance(P>0.05).When duration of infertility was studied,the CPR of PCOS patients'duration of infertility less than 5years and greater than 5 years was 23.97%and 23.33%,was not statistically significant(P>0.05).When the BMI factor was studied,the PCOS patients were divided into 3groups,the CPR of less than and equal to 18 Kg/m~2,18 Kg/m~2 to 28Kg/m~2,and greater than the 28Kg/m~2 group was 30%,23.81%and 18.75%,was not statistically significant(P>0.05).In the study of basic FSH factor,the number of FSH in pregnant PCOS patients and non pregnant PCOS patients was(6.768+1.447)IU/L and(6.588+1.660)IU/L,respectively,without statistical significance(P>0.05).When the basic LH factor was studied,the average LH was 8.420(5.680,12.825)IU/L in pregnant IUI group and the 10.955(5.958,15.860)IU/L in the non-pregnant IUI group.The two groups was not statistically significant(P>0.05).The CPR of PCOS patients'LH less than and equal to 10IU/L and greater than 10IU/L was 29.07%and 18.82%,was not statistically significant(P>0.05).The CPR of PCOS patients'LH less than and equal to 15IU/L and greater than 15IU/L was 26.83%and 16.67%,was not statistically significant(P>0.05).The CPR of PCOS patients'LH less than and equal to 20IU/L and greater than20IU/L was 25.66%and 10.53%,was not statistically significant(P>0.05).In the study of basal T factors,CPR was not statistically significant in PCOS patients when T was divided into 2groups,one group was T less than and equal to 2.98 nmol/L(23.98%)and the other group was T was more than 2.98 nmol/L(17.65%)(P>0.05).In the study of LH/FSH,when PCOS infertile patients were divided into 2 groups,the CPR of LH/FSH less than and equal to 2 and more than 2 groups was 29.20%and 13.79%,was statistically significant(P<0.05).Analysis asthenozoospermia factor group,the CPR of LH/FSH less than or equal to 2 and greater than 2 was 14.97%and 33.33%,had no statistical significance(P>0.05).In the study of the endometrial thickness of the trigger day,the average thickness was 10.000(8.450,11.000)mm in pregnant IUI group and9.00(8.000,10.100)IU/L in the non-pregnant IUI group.The CPR of PCOS patients were divided into less than and equal to 6mm,6mm to 12mm,and greater than the group12mm was 16.67%,24.83%and 29.17%,had no statistical significance(P>0.05),and the CPR of PCOS patients divided into less than and equal to 6mm,6mm to 14mm,and greater than the group 14mm was 16.67%,24.85%and 37.50%,had no statistical significance(P>0.05).When the endometrial morphology of the trigger day was studied,the CPR of PCOS patients divided into groups of A+B and C was 23.98%and6.45%,without statistical significance(P>0.05).There had no statistical significance(P>0.05)for CPR in the group of A+B(15.29%)and C(16.22%)in the asthenozoospermia factor group.In the study of ovulation-inducing treatments,the CPR of PCOS patients divided into oral pills,injection and oral pills+injection 3 group was18.00%,20.00%and 27.36%,without statistical significance(P>0.05).2.The results of 25.1%,21.13%and 15%of CPR were no significant difference(p>0.05)in the study of LH/FSH and endometrial morphology factors not accumulation and accumulation in patients with PCOS.According to LH/FSH?2 and>2,endometrial thickness of trigger day was A+B and C,PCOS patients were divided into fourgroups,but there was no statistically significantdifference in CPR(25.10%,13.16%,24.04%and 15.00%).When LH/FSH?2,the CPR of PCOS patients in the first,second and third cycle was 26.06%,19.23%and 20.00%,without statistical significance(P>0.05).When LH/FSH>2,the CPR of PCOS patients in the first,second and third cycle was 22.22%,24.32%and 25.00%,without statistical significance(P>0.05).3.The CPR of PCOS patients in the first,second and third cycle was 24.91%,20.87%and 20.83%,without statistical significance(P>0.05).The CPR of control group in the first,second and third cycle was 12.97%?10.15%?7.02%,without statistical significance.4.PCOS patients received IUI treatment and some people who failed with IUI go on received IVF/ICSI,these people's CPR was high,but without statistical significance(P>0.05).CPR was not relatived with used times of IUI,there was no statistical significance(P>0.05).Conclusions:1.When the age not more than 38 and FSH?12IU/L,PCOS infertile patients were treated with IUI,women's age,the rate of basic hormone LH/FSH,endometrial morphology of the trigger day had a significant influence on CPR.The higher the age and LH/FSH the lower the CPR,the A+B type of CPR was higher than the C type..2.When the age not more than 38 and FSH?12IU/L,duration of infertility,BMI,basal hormone FSH,LH,T,endometrial thickness of the trigger day and ovulation-inducing treatments had no significant influence on PCOS infertile patients'CPR treated with IUI.3.The CPR of PCOS patients'decreased with increasing IUI times.It was necessary for PCOS patients to perform at least 3 times IUI treatments.The sample size was small of 4 and more times,It was needed to expand the sample size after further study.4.The pregnancy outcome of PCOS patients who received IUI treatment then changed to IVF/ICSI had no relationship with the times of IUI.IVF/ICSI improved efficiency. |
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