The pregnancy outcomes of infertile women with polycystic ovary syndrome undergoing intrauterine insemination with different attempts of previous ovulation induction.
The pregnancy outcomes of infertile women with polycystic ovary syndrome undergoing intrauterine insemination with different attempts of previous ovulation induction.
复制标题
患有多囊卵巢综合征的不孕女性接受宫内人工授精并尝试不同的先前促排卵的妊娠结局。
DOI：
10.3389/fendo.2022.922605
复制
发表时间：
2022
影响因子：
5.2
通讯作者：
中科院分区：
文献类型：
--
作者：
多囊卵巢综合征(PCOS)是不孕症最常见的原因之一。治疗多囊卵巢综合征不孕妇女的共识是在体外受精(IVF)/卵胞浆内单精子注射(ICSI)之前进行6至9次促排卵(OI)。如今，一种新兴的非侵入性治疗-宫腔人工授精(IUI)受到了更多的关注，因为一些专家认为IUI可以使患有不孕症的PCOS患者受益。我们的研究旨在调查PCOS患者的IUI结局，以及患者既往的OI周期是否可以作为IUI结局的预测因素。研究对象为上海市第九人民医院辅助生殖科2007-01/2021-07收治的1,086例多囊卵巢综合征患者，1,868个IUI周期。所有患者均接受来曲唑+人绝经期促性腺激素(LE+HMG)的IUI刺激卵巢治疗。妊娠结局与先前失败的OI周期的尝试无关。无OI周期的PCOS患者的临床妊娠率为21.14%，有1~2个OI周期的PCOS患者的临床妊娠率为21.95%，有3个或以上OI周期的PCOS患者的临床妊娠率为23.64%(P=0.507)。活产率分别为16.64%、18.06%和18.68%，差异无统计学意义(p=0.627)。临床妊娠和活产的累积妊娠率分别为38.59%和31.03%，约98%的妊娠发生在IUI的前3个周期。不同OI周期的多囊卵巢综合征患者在IUI后的妊娠结局相似，因此反复OI治疗失败的病史不是IUI周期妊娠结局的预测因素。大多数妊娠发生在IUI的前三个周期，所以我们强烈建议PCOS妇女在转向IVF/ICSI之前尝试三次IUI。一般来说，IUI可能是IVF/ICSI前PCOS不孕妇女的辅助手段，并可能在不进行侵入性操作的情况下加速目标妇女的怀孕。
Polycystic ovary syndrome (PCOS) is one of the most common reasons for infertility. The consensus of the treatment of infertile women with PCOS is ovulation induction (OI) for six to nine attempts before in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI). Nowadays, more attention was paid to a rising, noninvasive treatment, intrauterine insemination (IUI), as some experts claimed IUI could benefit PCOS patients with infertility. Our study means to investigate the outcomes of IUI for PCOS patients and if patients’ previous OI cycles can be a predictive factor for IUI outcomes. A total of 1,086 PCOS patients was included and 1,868 IUI cycles were performed between January 2007 and July 2021 in the department of assisted reproduction in Shanghai Ninth People’s Hospital. All included patients underwent IUI treatments with letrozole+human menopausal gonadotropin (LE+hMG) for ovarian stimulation. The pregnancy outcomes were not associated with the attempts of failed OI cycles previously. Specifically, the clinical pregnancy rate was 21.14% for PCOS patients without previous OI cycles, 21.95% for PCOS patients with 1-2 previous OI cycles and 23.64% for PCOS patients with 3 or more previous OI cycles (p=0.507). The corresponding live birth rate was 16.64%, 18.06%, and 18.68%, respectively, of which the difference was not statistically significant (p=0.627). The cumulative rate per patient was 38.59% for clinical pregnancy and 31.03% for live birth, and approximately 98% of the pregnancies occurred in the first 3 cycles of IUI. PCOS women with different attempts of OI cycles had similar pregnancy outcomes after IUI, thus a history of repeated failures of OI treatments was not a predictive factor for the pregnancy outcomes in IUI cycles. Most pregnancies occurred in the first three cycles of IUI, so we strongly recommended three attempts of IUI for PCOS women before they switched to IVF/ICSI. Generally, IUI might be an assist for infertile women with PCOS before IVF/ICSI and might accelerate pregnancy for target women without invasive manipulations.