摘要
目的探讨不同诱导排卵(OI)方案与自然周期(NC)对不明原因不孕夫妇宫腔内人工授精(IUI)助孕结局的影响。方法回顾性分析2012年1月至2019年12月由1710对不明原因不孕夫妇完成的第1~2个IUI周期(共2642个周期)的超声和临床资料。比较单用克罗米芬(CC)、来曲唑(LE)、或联合小剂量促性腺激素(Gn)、或单用小剂量Gn诱导排卵周期与NC的参数和临床结局。采用单因素分析和多因素Logistic回归分析矫正混杂因素,探讨周期方案与宫内妊娠、活产、早期妊娠丢失的相关性。结果整体上,6种周期方案的宫内妊娠率、活产率均有统计学差异(P<0.05),早期妊娠丢失率、异位妊娠率均无统计学差异(P>0.05);与NC方案的宫内妊娠率(8.20%)比较,单用CC(13.77%,P=0.003)、CC联合Gn(18.18%,P=0.001)、单用Gn方案(13.90%,P=0.006)的宫内妊娠率均显著升高;与NC方案的活产率(7.65%)比较,单用CC(12.57%,P=0.007)、CC联合Gn方案(15.45%,P=0.006)的活产率均显著升高。矫正混杂因素后,与NC方案比较,单用CC、CC联合Gn、单用Gn均可显著提高宫内妊娠率[分别为OR=1.530,P=0.042;OR=2.067,P=0.011;OR=1.725,P=0.012)及活产率[分别为OR=1.720,P=0.013;OR=2.197,P=0.010;OR=1.686,P=0.027),而单用LE、LE联合Gn对宫内妊娠率和活产率均无显著影响(P>0.05);5种OI方案对早期妊娠丢失均无显著影响(P>0.05)。结论不明原因不孕夫妇IUI助孕中的诱导排卵方案可优先考虑单用CC、CC联合小剂量Gn或单用小剂量Gn。
Objective:To compare the effects of different ovulation induction protocols and natural cycle(NC)on the outcome of intrauterine insemination(IUI)for the couples with unexplained infertility.Methods:The ultrasonic and clinical data of 1710 couples with unexplained infertility who completed the first to second IUI cycles(n=2642)in our reproductive center from January 2012 and December 2019 were retrospectively analyzed.The cycle parameters and clinical outcomes of IUI cycles using clomiphene citrate(CC)or letrozole(LE)alone,or combined with low-dose gonadotropin(Gn),or low-dose Gn alone for ovulation induction were compared with those of NC.After univariate analysis and multivariate logistic regression were used to correct the confounding factors,the correlation between cycle protocols and intrauterine pregnancy,live birth and early pregnancy loss were explored.Results:There were significant differences in intrauterine pregnancy rate and live birth rate(P<0.05),but no significant difference in early pregnancy loss rate or ectopic pregnancy rate(P<0.05)among the six protocols.Compared with the intrauterine pregnancy rate of NC protocol(8.20%),the intrauterine pregnancy rate of CC alone(13.77%,P=0.003),CC combined with Gn(18.18%,P=0.001)and Gn alone(13.90%,P=0.006)increased significantly.Compared with the live birth rate of NC protocol(7.65%),that of CC alone(12.57%,P=0.007)and CC combined with Gn protocol(15.45%,P=0.006)increased significantly.After adjusted for confounders,the protocol of CC alone,CC combined with Gn or Gn alone significantly increased intrauterine pregnancy rate(OR=1.530,P=0.042;OR=2.067,P=0.011;OR=1.725,P=0.012,respectively)and live birth rate(OR=1.720,P=0.013;OR=2.197,P=0.010;OR=1.686,P=0.027,respectively)compared with NC,while LE alone or combined with Gn had no significantly difference(P>0.05).None of the five ovulation induction protocols significantly affected early pregnancy loss rate(P>0.05).Conclusions:The ovulation induction protocols for couples with unexplained infertility in IUI procedure can give priority to CC alone,CC combined with low-dose Gn,and low-dose Gn alone.
作者
倪丽莉
王菁
刁飞扬
马翔
刘嘉茵
袁纯
NI Li-li;WANG Jing;DIAO Fei-yang;MA Xiang;LIU Jia-yin;YUAN Chun(Reproductive Medicine Center,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029)
出处
《生殖医学杂志》
CAS
2021年第10期1272-1279,共8页
Journal of Reproductive Medicine
基金
国家重点研发计划(2018YFC100258,2016YFC1000603)
国家自然科学青年基金(81901449)
江苏省卫生厅项目(YXZXB2016001)。
关键词
不明原因不孕
诱导排卵
宫内妊娠
活产
早期妊娠丢失
Unexplained infertility
Ovulation induction
Intrauterine pregnancy
Live birth
Early pregnancy loss
