Clomiphene citrate and intrauterine insemination: analysis of more than 4100 cycles
Clomiphene citrate and intrauterine insemination: analysis of more than 4100 cycles
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DOI：
10.1016/j.fertnstert.2007.10.057
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发表时间：
2008-12-01
影响因子：
6.7
通讯作者：
Penzias, Alan S.
中科院分区：
文献类型：
--
作者：
Dovey, Serena;Sneeringer, Rita M.;Penzias, Alan S.
目的：评价一大批接受枸橼酸克罗米芬联合宫内人工授精治疗的不孕患者的预后。设计：回顾性队列研究。环境：波士顿试管婴儿，一个大型大学附属生殖医学实践。患者：2002年9月至2007年7月期间，1738名不孕症患者共进行了4199次周期。干预(S)：所有患者口服枸橼酸克罗米芬，完成周期的患者行宫内人工授精。主要结局指标：在按年龄、已完成周期和治疗意向（ITT）定义的患者亚群中实现的累积妊娠率和每个周期妊娠率。结果：对于35岁以下的女性，983例患者启动了2351个周期。总共有238例妊娠，每个完整周期的妊娠率（PR）为11.5%，ITT开始的每个周期的妊娠率为10.1%。在35-37岁的妇女中，422名妇女中有947例周期导致每完成周期的PR和ITT分别为9.2%和8.2%。对于38-40岁的患者，265名女性的614个周期导致每个完整周期的PR和ITT分别为7.3%和6.5%。在41-42岁的女性中，81例患者的166个周期导致每个完整周期的PR和ITT分别为4.3%和3.6%。对于42岁以上的女性，55例患者的120个周期导致每个完整周期的PR和ITT分别为1.0%和0.8%。在每个接受治疗的患者基础上，35岁以下的累积pr为24.2%，35-37岁的为18.5%，38-40岁的为15.1%，而41-42岁的只有7.4%，42岁以上的只有1.8%怀孕（55例患者中有1例怀孕）。结论：正如预期的那样，年轻患者每个周期的PR高于老年患者。仅开始一个或两个治疗周期的患者的每个周期的PR明显高于周期3至9的相应每个周期的PR。在41岁和42岁的患者中，每个患者的成功率急剧下降，但42岁以上的患者成功率异常低，这表明CC合并IUI实际上在他们的治疗中没有地位。[j] .中国农业科学（英文版），2008;30(1):1-6。(C) 2008年，美国生殖医学学会。)
Objective: To evaluate the outcomes of a large cohort of patients undergoing fertility treatment with clomiphene citrate and intrauterine insemination.Design: A retrospective cohort study.Setting: Boston IVF, a large university-affiliated reproductive medicine practice.Patient(s): A total of 4,199 cycles performed in 1,738 infertility patients between September 2002 and July 2007.Intervention(S): All patients received oral clomiphene citrate, and patients with completed cycles had intrauterine insemination performed.Main Outcome Measure(s): Cumulative and per cycle pregnancy rates achieved among subsets of patients defined by age, completed cycles, and intention to treat (ITT).Result(s): For women under age 35 years, 2,351 cycles were initiated in 983 patients. A total of 238 pregnancies ensued, yielding a pregnancy rate (PR) per completed cycle of 11.5% and 10.1% per cycle initiated with ITT. In women aged 35-37 years, 947 cycles in 422 women lead to a PR per completed cycle and ITT of 9.2% and 8.2%, respectively. For patients aged 38-40 years, 614 cycles in 265 women lead to a PR per completed cycle and ITT of 7.3% and 6.5%, respectively. In women aged 41-42 years, 166 cycles in 81 patients lead to a PR per completed cycle and ITT of 4.3% and 3.6%, respectively. For women above age 42 years, 120 cycles in 55 patients lead to a PR per completed cycle and ITT of 1.0% and 0.8%, respectively. On a per-patient treated basis, cumulative PRs were 24.2% under age 35, 18.5% ages 35-37, and 15.1% ages 38-40, whereas only 7.4% ages 41-42 and 1.8% above 42 became pregnant (one pregnancy in 55 patients).Conclusion(s): As anticipated, younger patients have a higher PR per cycle than older patients. The PR per cycle for patients who initiate only one or only two treatment cycles is notably higher than the corresponding per cycle rates for cycles 3 through 9. The drop in success per patient among 41- and 42-year-olds is sharp, but the exceptionally low success rate above age 42 suggests that CC with IUI has virtually no place in their treatment:. (Fertil Steril (R) 2008;90:2281-6. (C) 2008 by American Society for Reproductive Medicine.)