Low-dose human menopausal gonadotrophin versus natural cycles in intrauterine insemination for subfertile couples with regular menstruation
Low-dose human menopausal gonadotrophin versus natural cycles in intrauterine insemination for subfertile couples with regular menstruation
复制标题
DOI：
10.1186/s13048-020-00638-3
复制
发表时间：
2020-04-04
影响因子：
4
通讯作者：
Liu, Jianqiao
中科院分区：
文献类型：
--
作者：
Li, Sichen;He, Yuxia;Liu, Jianqiao
背景：月经不调的妇女应考虑从卵巢刺激中获益。然而，大多数文献没有将排卵障碍与正常月经周期分开。本研究的目的是探讨在月经规律的低生育力夫妇行IUI时，与自然周期相比，卵巢温和刺激的优越性。方法回顾性研究在一个单一的医疗中心，其中2413对夫妇的3573 IUI周期从2013年至2018年进行了研究。分析自然周期与低剂量HMG诱导周期的IUI结果。结果对于月经周期正常的年轻妇女（< 35岁），HMG促排卵联合IUI可提高临床妊娠率（两个卵泡诱导周期的临床妊娠率为13.55%，自然周期的临床妊娠率为7.23%，P < 0.01），即使只诱导一个卵泡，临床妊娠率也可提高到10.32%（P < 0.01）。当HMG周期诱导两个生长卵泡时，活产率显著提高（10.28%比自然周期的5.91%，p < 0.05）。同时，双胎妊娠率上升至20.69%（p < 0.01）。双胎妊娠显示异位妊娠和早产的风险显著增加（两者p = 0.00）。对于月经周期规律的高龄妇女（年龄≥ 35岁），促排卵并不能提高临床妊娠率和活产率，而年龄是唯一相关因素。结论HMG促排卵联合IUI可改善月经周期正常的年轻妇女的妊娠结局。1-2直径>= 14 mm的卵泡作为诱导排卵的目的。有两个生长卵泡的HMG周期的双胎妊娠率和异位妊娠率均显著高于自然周期。因此，医生在作出选择前必须评估风险，并告知病人，以达到最佳效果。对于月经周期正常的晚期妇女，自然IUI周期是可选的。
Background Women with irregular menstruation should be considered to benefit from the ovarian stimulation. However, most literature did not separate ovulatory disorders from normal menstrual cycles. Our purpose was to assess the superiority of ovarian mild stimulation compared with the natural cycle in IUI for subfertile couples when the women with regular menstruation. Methods A retrospective study in a single medical center in which 2413 couples with 3573 IUI cycles were studied from 2013 to 2018. The results of IUI in natural cycles versus low-dose HMG induced cycles were analyzed. Results For young women (age < 35 years) with normal menstrual cycle, HMG induced ovulation combined with IUI can improve clinical pregnancy outcome (13.55% in two follicular induced cycles vs. 7.23% in natural cycles, p < 0.01); even if only one follicle was induced, the clinical pregnancy rate was increased to 10.32% (p < 0.01). When two growth follicles were induced in HMG cycles, a remarkable improvement of the live birthrate (10.28% vs. 5.91% in natural cycles, p < 0.05) was noted. Simultaneously, twin pregnancy rates were increased to 20.69% (p < 0.01). Twin pregnancies showed significantly increased risk of both ectopic pregnancy and preterm birth (p = 0.00 for both). For advanced women (age >= 35 years) with regular menstrual cycle, ovulation induction didn't improve clinical pregnancy and live birthrates, while age was the only relevant factor. Conclusions Combining HMG induced ovulation and IUI can improve pregnancy outcome in young women with normal menstrual cycles. 1-2 follicles with diameter >= 14 mm served as the purpose of ovulation induction. Further, both twin and ectopic pregnancy rate in HMG cycles with two growth follicles were significantly higher than those in natural cycles were. Therefore, doctors must evaluate the risk before making choices and inform the patients to achieve the best results. For advanced women with normal menstrual cycles, natural IUI cycles were optional.