Effect of diagnosis, age, sperm quality, and number of preovulatory follicles on the outcome of multiple cycles of clomiphene citrate-intrauterine insemination
Effect of diagnosis, age, sperm quality, and number of preovulatory follicles on the outcome of multiple cycles of clomiphene citrate-intrauterine insemination
复制标题
DOI：
10.1016/s0015-0282(02)04212-7
复制
发表时间：
2002-11-01
影响因子：
6.7
通讯作者：
Pyrzak, R
中科院分区：
文献类型：
--
作者：
Dickey, RP;Taylor, SN;Pyrzak, R
目的：为了确定诊断、年龄、精子质量和排卵前卵泡数量如何影响多个周期的克罗米芬-IUI的妊娠率，设计：15年前瞻性观察研究，设置：私人不孕症诊所，患者：3381个周期的丈夫或供体IUI，干预：用CC和IUI诱导排卵主要结果指标：结果：妊娠率在4个周期内基本保持不变，但在排卵功能障碍以外的诊断中妊娠率明显下降。具有以下特征的患者第1-4周期的平均PR显著较低：年龄大于或等于43岁，精液质量差，单个排卵前卵泡，诊断为排卵功能障碍以外的疾病。额外的CC-IUI周期补偿了由于年龄、精液质量或卵泡数量而导致的低PR。4个周期后，排卵功能障碍的CPR为46%;宫颈因素、男性因素和不明原因不孕的CPR为38%;子宫内膜异位症的CPR为34%;输卵管因素的CPR为26%。六个周期后，CPRs为65%的排卵功能障碍，35%的子宫内膜异位症，和不变的其他diagnosis. Conclusions（S）：克罗米芬宫腔内人工授精应进行至少四个周期。额外的CC-IUI周期可以弥补排卵功能障碍患者由于年龄，精液质量或卵泡数量而导致的低妊娠率。
Objective: To determine how diagnosis, age, sperm quality, and number of preovulatory follicles affect pregnancy rates when multiple cycles of clomiphene citrate (CC)-IUI are performed.Design: Fifteen-year prospective observational study.Setting: Private infertility clinic.Patient(s): Three thousand, three hundred eighty-one cycles of husband or donor IUI.Intervention(s): Ovulation induction with CC and IUIMain Outcome Measure(s): Per-cycle pregnancy rate (PR), cumulative pregnancy rate (CPR).Result(s): Pregnancy rates remained constant through four cycles, then fell significantly for diagnoses other than ovulatory dysfunction. Mean PRs for cycles 1-4 were significantly lower for patients with the following characteristics: age greater than or equal to43 years, poor semen quality, single preovulatory follicles, and diagnoses other than ovulatory dysfunction. Additional cycles of CC-IUI compensated for low PRs because of age, semen quality, or number of follicles. After four cycles, CPRs were 46% for ovulatory dysfunction; 38% for cervical factor, male factor, and unexplained infertility; 34% for endometriosis; and 26% for tubal factor. After six cycles, CPRs were 65% for ovulation dysfunction, 35% for endometriosis, and unchanged for other diagnoses.Conclusion(s): Clomiphene citrate-intrauterine insemination should be performed for a minimum of four cycles. Additional cycles of CC-IUI can compensate for low pregnancy rates due to age, semen quality, or follicle number in patients with ovulation dysfunction.