Influences on endometrial development during intrauterine insemination: clinical experience of 2,929 patients with unexplained infertility.
Influences on endometrial development during intrauterine insemination: clinical experience of 2,929 patients with unexplained infertility.
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DOI：
10.1016/j.fertnstert.2013.03.023
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发表时间：
2013-07
影响因子：
6.7
通讯作者：
Widra, Eric
中科院分区：
文献类型：
--
作者：
Wolff, Erin Foran;Vahidi, Nima;Alford, Connie;Richter, Kevin;Widra, Eric
研究不明原因不孕症患者行IUI治疗后与子宫内膜发育不良的关系。对2004-2011年间的2929名患者进行了回顾。大都市的不孕不育实践。不明原因不孕症患者在年龄不到43岁时接受第一次人工授精周期，总活动性精子数≥为800万。克罗米芬(CC)和促卵泡刺激素(FSH)刺激，然后IUI。子宫内膜厚度、注射hCG当天的血清E2水平(以皮克/毫升为单位)、体重指数(以公斤/平方米为单位)、活动精子总数、卵泡数和临床妊娠情况。在符合纳入标准的2929名患者中，466名(15.9%)实现了临床妊娠。多因素Logistic回归分析显示，妊娠率随hCG注射日子宫内膜厚度的增加和血清E2水平的升高而显著增加，但与年龄、体重指数、卵泡数无明显关系。子宫内膜峰值厚度随年龄和雌二醇水平的升高而降低。BMI与较厚的子宫内膜有关，但也与较低的E2峰值水平有关。在IUI治疗中，“子宫内膜因素”不孕的影响可能被低估。优化子宫内膜的靶向治疗是当前提高生育成功率的一个重要的新领域。
To characterize relationships associated with adverse endometrial development in patients undergoing IUI for unexplained infertility. A retrospective review of 2,929 patients from 2004–2011. Large metropolitan infertility practice. Patients with unexplained infertility undergoing first IUI cycle at age less than 43 years, with a total motile sperm count ≥8 million. Clomiphene citrate (CC) with FSH stimulation followed by IUI. Endometrial thickness, serum E2 (in picograms per milliliter) levels on the day of hCG trigger administration, body mass index (BMI) (in kilograms per meter squared), total motile sperm, follicle number, and clinical pregnancy. Of the 2,929 patients who met the inclusion criteria, 466 (15.9 %) achieved a clinical pregnancy. Pregnancy rates (PRs) increased significantly with increasing endometrial thickness on the day of hCG administration and with increasing serum E2 level, but were not significantly related to age, BMI, or follicle numbers according to multiple logistic regression modeling. Peak endometrial thickness declined with age and increasing E2 levels. The BMI was associated with thicker endometrium, but it was also associated with lower peak E2 levels. The impact of “endometrial factor” infertility may be underappreciated in IUI therapy. Targeted therapies to optimize the endometrium represent an important new area to improve in current fertility success rates.
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