The Effect of Spontaneous LH Surges on Pregnancy Outcomes in Patients Undergoing Letrozole-HMG IUI: A Retrospective Analysis of 6,285 Cycles.
The Effect of Spontaneous LH Surges on Pregnancy Outcomes in Patients Undergoing Letrozole-HMG IUI: A Retrospective Analysis of 6,285 Cycles.
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自发 LH 激增对接受来曲唑-HMG IUI 患者妊娠结局的影响：6,285 个周期的回顾性分析。
DOI：
10.3389/fendo.2022.880538
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发表时间：
2022
影响因子：
5.2
通讯作者：
Kuang, Yanping
中科院分区：
文献类型：
--
作者：
Jiang, Shutian;Chen, Li;Gao, Yining;Xi, Qianwen;Li, Wenzhi;Zhao, Xinxi;Kuang, Yanping
迄今为止，对于是否等待自发性黄体生成素 (LH) 激增或无论是否存在 LH 激增而触发排卵，以在宫内授精 (IUI) 周期中获得更高的成功率，尚未达成共识。因此，我们希望研究来曲唑-人绝经期促性腺激素 (LE-HMG) IUI 周期中自发性 LH 激增对妊娠结局的影响。在这项回顾性队列研究中，2010 年 1 月至 2021 年 5 月期间总共纳入了 6,285 个 LE-HMG IUI 周期。周期分为三组：触发 + LH 激增组、仅触发组和仅 LH 激增组。主要结局指标是临床妊娠率。进行逻辑回归分析以探讨影响临床妊娠率的其他危险因素。三组生化妊娠率（P=0.640）、临床妊娠率（P=0.702）、持续妊娠率（P=0.842）和活产率（P=0.951）差异无统计学意义。二元逻辑回归分析还证实，LH 激增的存在与临床妊娠无关。异位妊娠率存在差异（P = 0.045），但逻辑回归显示自发 LH 激增的存在与异位妊娠无关。尽管如此，与铅卵泡在 14.1-16.0 mm 和 LE 治疗时间较短的患者相比，铅卵泡在 18.1-20.0 mm/20.1-22.0 mm 范围内且 LE 治疗时间较长的患者异位妊娠的可能性较小（OR：0.142，95% CI：0.023-0.891，P = 0.037；OR： 0.142，95% CI：0.022–0.903，P = 0.039；OR：0.445，95% CI：0.235–0.840，P = 0.013）。在触发的 LE-HMG IUI 周期中出现自发 LH 激增似乎不会提高妊娠率。因此，我们建议在触发的 LE-HMG IUI 周期中无需等待 LH 激增的发生。
To date, no consensus has been reached on whether to wait for spontaneous luteinizing hormone (LH) surge to occur or to trigger ovulation regardless of the presence of an LH surge for achieving higher success rate in intrauterine insemination (IUI) cycles. Therefore, we hope to investigate the effect of the presence of a spontaneous LH surge on pregnancy outcomes in letrozole–human menopausal gonadotropin (LE-HMG) IUI cycles. In this retrospective cohort study, a total of 6,285 LE-HMG IUI cycles were included between January 2010 and May 2021. Cycles were categorized into three groups: the trigger + LH surge group, the trigger only group, and the LH surge only group. The primary outcome measure was the clinical pregnancy rate. A logistic regression analysis was performed to explore other risk factors affecting the clinical pregnancy rate. No significant differences were observed in biochemical pregnancy rate (P =0.640), clinical pregnancy rate (P =0.702), ongoing pregnancy rate (P =0.842), and live birth rate (P =0.951) among the three groups. The binary logistic regression analysis also confirmed that the existence of an LH surge was not associated with clinical pregnancy. There was a difference in ectopic pregnancy rates (P =0.045), but logistic regression showed that the presence of a spontaneous LH surge has no association with ectopic pregnancy. Nonetheless, patients with lead follicles within 18.1-20.0 mm/20.1-22.0 mm and a long duration of LE treatment were less likely to get ectopic pregnant compared with patients with 14.1-16.0 mm lead follicles and shorter LE treatment (OR: 0.142, 95% CI: 0.023–0.891, P =0.037; OR: 0.142, 95% CI: 0.022–0.903, P =0.039; OR: 0.445, 95% CI: 0.235–0.840, P = 0.013). The presence of a spontaneous LH surge in triggered LE-HMG IUI cycles does not appear to improve pregnancy rates. Thus, we suggest that waiting for an LH surge to occur is not necessary in triggered LE-HMG IUI cycles.
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