PREDICTING AND OPTIMIZING SUCCESS IN AN INTRAUTERINE INSEMINATION PROGRAM
PREDICTING AND OPTIMIZING SUCCESS IN AN INTRAUTERINE INSEMINATION PROGRAM
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DOI：
10.1093/oxfordjournals.humrep.a138385
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发表时间：
1994-11-01
影响因子：
6.1
通讯作者：
AMATO, P
中科院分区：
文献类型：
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作者：
PLOSKER, SM;JACOBSON, W;AMATO, P
我们分析了 215 对不孕夫妇的 381 个连续同源宫内授精 (IUI) 周期，导致 48 例怀孕（12.6%/周期，22.3%/患者）。 25-39岁女性的周期生育力范围为0.11至0.14，40岁以上则降至0.04。 48 例妊娠中，43 例发生在前三个治疗周期，生育力分别为 0.14、0.16 和 0.10。超过三个周期后，繁殖力为 0.07（与前两个周期相比，P = 0.05）。妊娠的发生率因诊断而异（P = 0.04）。排卵功能障碍的女性 (0.30) 的生育能力明显高于子宫内膜异位症、男性因素、输卵管因素、特发性不孕或多因素 (0.08-0.14) 的女性。使用绝经期促性腺激素诱导排卵比自然周期或使用不含促性腺激素的克罗米芬柠檬酸盐的周期具有显着优势（0.15 与 0.03，P = 0.01）。人绒毛膜促性腺激素 (HCG) 诱导或支持的排卵前激增的周期优于自发黄体生成激素激增（0.13 与 0.03，P = 0.05）。招募至少两个成熟（>1.6 cm）卵泡至关重要。具有 1 个成熟卵泡的 64 个周期中仅发生 1 次妊娠，而具有 2 个或更多成熟卵泡的周期中的妊娠率为 0.15 (P = 0.006)。 IUI对40岁以上的女性不利，三个周期内成功的机会最大。为了达到可接受的妊娠率，需要使用基于促性腺激素的刺激方案和中期 HCG 来招募多个卵泡。
We analysed 381 consecutive cycles of homologous intrauterine insemination (IUI) in 215 infertile couples, resulting in 48 pregnancies (12.6%/cycle, 22.3%/patient). Cycle fecundity ranged from 0.11 to 0.14 in women aged 25-39 years, falling to 0.04 beyond age 40 years. Of the 48 pregnancies, 43 occurred in the first three treatment cycles, in which fecundity was 0.14, 0.16 and 0.10 respectively. Beyond three cycles, fecundity was 0.07 (P = 0.05 versus first two cycles). The occurrence of pregnancy varied with diagnosis (P = 0.04). Fecundity was significantly greater for women with ovulatory dysfunction (0.30) than for endometriosis, male factor, tubal factor, idiopathic infertility or multifactorial (0.08-0.14). Ovulation induction using menopausal gonadotrophins offered significant advantage over natural cycles or cycles using clomiphene citrate without gonadotrophins (0.15 versus 0.03, P = 0.01). Cycles in which pre-ovulatory surges were either induced or supported with human chorionic gonadotrophin (HCG) were superior to spontaneous luteinizing hormone surges (0.13 versus 0.03, P = 0.05). Recruitment of at least two mature (>1.6 cm) follicles was critical. Only one pregnancy occurred in 64 cycles characterized by one mature follicle, compared with a pregnancy rate of 0.15 in cycles characterized by two or more mature follicles (P = 0.006). IUI is not beneficial to women >40 years old, and has the best chance of success within three cycles. Multiple follicle recruitment using gonadotrophin-based stimulation protocols and mid-cycle HCG are necessary to achieve an acceptable pregnancy rate.