Optimal lead follicle size in letrozole human menopausal gonadotrophin intrauterine insemination cycles with and without spontaneous LH surge
Optimal lead follicle size in letrozole human menopausal gonadotrophin intrauterine insemination cycles with and without spontaneous LH surge
复制标题
来曲唑人绝经期促性腺激素宫内授精周期中带或不带自发性 LH 激增的最佳卵泡大小。
DOI：
10.1016/j.rbmo.2022.11.003
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发表时间：
2023-03-02
影响因子：
4
通讯作者：
Kuang, Yanping
中科院分区：
文献类型：
--
作者：
Chen, Li;Jiang, Shutian;Kuang, Yanping
研究问题：来曲唑、人绝经期促性腺激素和宫腔内人工授精（IUI）周期伴或不伴自发性LH峰的最佳先导卵泡大小是多少？设计：这项回顾性队列研究纳入了2010年1月至2021年5月期间的3797个来曲唑HMG IUI周期。所有周期分为两组：HCG触发组（触发日LH = 15 mIU/ml）和自发LH峰组（触发日LH >15 mIU/ml）。根据卵泡直径将这两组再分为更小的组。主要结局指标为临床妊娠率。结果：在HCG触发组中，16.1-18.0 mm、18.1-20.0 mm和20.1-22.0 mm的临床妊娠率分别为20.8%、14.9%和11.8%（P = 0.005）。在自发LH峰组中，14.1-16.0 mm卵泡的妊娠率显著高于20.1-22.0 mm卵泡（校正OR 0.533，95% CI 0.308 ~ 0.923，P = 0.025）。此外，有两个先导卵泡的患者实现临床妊娠的可能性是只有一个先导卵泡的患者的2.569倍（调整后OR 2.569，95% CI 1.258至5.246，P = 0.010）。不孕症的持续时间也被发现是一个共同的影响因素，在这两个group.Conclusions：最佳的引导卵泡大小为16.1和18.0毫米之间的HCG触发来曲唑HMG IUI周期。如果自发LH峰出现时，先导卵泡尺寸相对较小（14.1-18.0 mm），则无需取消IUI周期。
Research question: What is the optimal lead follicle size in letrozole, human menopausal gonadotrophin and intrauterine insemination (IUI) cycles with and without spontaneous LH surges?Design: This retrospective cohort study included 3797 letrozole HMG IUI cycles between January 2010 and May 2021. All cycles were divided into two groups: the HCG trigger group (trigger day LH = 15 mIU/ml) and the spontaneous LH surge group (trigger day LH >15 mIU/ml). These two groups were subdivided into smaller groups based on the diameter of the follicles. The primary outcome measure was clinical pregnancy rate. Logistic regression analysis was conducted to explore other risk factors.Results: In the HCG trigger group, the clinical pregnancy rate varied significantly, with rates of 20.8%, 14.9% and 11.8% for the 16.1-18.0, 18.1-20.0 and 20.1-22.0 mm groups, respectively (P = 0.005). In the spontaneous LH surge group, the pregnancy rate of follicles within 14.1-16.0 mm was significantly higher than that of follicles within 20.1-22.0 mm (adjusted OR 0.533, 95% CI 0.308 to 0.923, P = 0.025). Also, patients with two lead follicles were 2.569 times more likely to achieve a clinical pregnancy than those with only one lead follicle (adjusted OR 2.569, 95% CI 1.258 to 5.246, P = 0.010). The duration of infertility was also found to be a common influencing factor in both groups.Conclusions: The optimal lead follicle size was between 16.1 and 18.0 mm in HCG-triggered letrozole HMG IUI cycles. If the lead follicle size is relatively small (14.1-18.0 mm) when a spontaneous LH surge occurs, there is no need to cancel the IUI cycle.