Fertility treatments and outcomes among couples seeking fertility care: data from a prospective fertility cohort in the United States
Fertility treatments and outcomes among couples seeking fertility care: data from a prospective fertility cohort in the United States
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DOI：
10.1016/j.fertnstert.2010.06.043
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发表时间：
2011-01-01
影响因子：
6.7
通讯作者：
Katz, Patricia P.
中科院分区：
文献类型：
--
作者：
Smith, James F.;Eisenberg, Michael L.;Katz, Patricia P.
目的：确定生育治疗周期数与妊娠率之间的关系。设计：前瞻性队列研究。设置：八个社区和学术不孕不育诊所。患者：四百八 (408) 对进行不孕不育评估的夫妇。干预措施：面对面和电话访谈和问卷调查。主要结果指标：怀孕率。 Cox 回归分析比较了多变量调整后基于周期的生育治疗与不基于周期的生育治疗的疗效。结果：使用一到两个纯药物周期的夫妇的妊娠率显着较高（风险比 [HR] 4.7 [95% 置信区间 1.3-16.6]），但在三个或更多周期后，这种益处不会持续存在（HR 0.6 [0.1-3.2]）。使用 IUI 一个周期（HR 2.9 [1.4-5.8]）、两个周期（HR 2.0 [0.9-4.5]）和三个周期（HR 4.5 [1.8-10.9]）的夫妇更有可能怀孕。使用四个或更多 IUI 周期的夫妇没有看到额外的好处（HR 1.0 [0.4-2.6]）。对于使用一个周期（HR 2.8 [1.5-5.2]）和两个周期（HR 2.2 [1.2-4.1]）的夫妇来说，体外受精具有显着的益处。使用三个或更多 IVF 周期的夫妇怀孕的可能性较高（HR 1.3 [0.7-2.4]），但没有统计学意义。 结论：基于周期的生育治疗可能会为不孕夫妇提供收益递减点：仅两个周期的药物治疗、三个周期的 IUI 和两个周期的 IVF。 （Fertil Steril (R) 2011；95: 79-84。(C)2011，美国生殖医学会。）
Objective: To determine the relationship between number of fertility treatment cycles and pregnancy rates.Design: Prospective cohort study.Setting: Eight community and academic infertility practices.Patient(s): Four hundred eight (408) couples presenting for an infertility evaluation.Intervention(s): Face-to-face and telephone interviews and questionnaires.Main Outcome Measure(s): Incidence of pregnancy. Cox regression analysis compared the efficacy of cycle-based fertility treatments with no cycle-based fertility treatment after multivariable adjustment.Result(s): Couples using one to two medications-only cycles had a significantly higher pregnancy rate (hazard ratio [HR] 4.7 [95% confidence interval 1.3-16.6]), a benefit that did not persist after three or more cycles (HR 0.6 [0.1-3.2]). Couples using IUI for one (HR 2.9 [1.4-5.8]), two (HR 2.0 [0.9-4.5]), and three cycles (HR 4.5 [1.8-10.9]) were more likely to achieve a pregnancy. No additional benefit was seen for couples using four or more IUI cycles (HR 1.0 [0.4-2.6]). In vitro fertilization was associated with significant benefit for couples using one (HR 2.8 [1.5-5.2]) and two cycles (HR 2.2 [1.2-4.1]). Couples using three or more IVF cycles had a non-statistically significant higher likelihood of pregnancy (HR 1.3 [0.7-2.4]).Conclusion(s): Cycle-based fertility treatments may offer a point of diminishing returns for infertile couples: two cycles of medications only, three cycles of IUI, and two cycles of IVF. (Fertil Steril (R) 2011; 95: 79-84. (C)2011 by American Society for Reproductive Medicine.)