| 134 | 2 | 62 |
| 下载次数 | 被引频次 | 阅读次数 |
目的 探讨来曲唑(LE)联合人绝经期促性腺激素(HMG)促排卵对不明原因性不孕患者行宫腔内夫精人工授精(AIH)妊娠及围产结局的影响。方法 回顾性分析2016年1月至2022年12月于我院生殖医学科首次AIH助孕的不明原因性不孕患者(340个周期，340例患者)的临床资料，根据促排卵方案分成两组：LE联合HMG组(n=154)和单独使用LE组(n=186),比较两组患者的临床特征和促排卵结局，采用多因素Logistic回归分析临床妊娠率及活产率的相关影响因素。结果 两组间的年龄、不孕年限、窦卵泡数、卵泡直径、HCG日子宫内膜厚度及AIH优化后男方精子浓度比较均无显著性差异(P>0.05);LE联合HMG组患者的体质量指数(BMI)、促排卵天数、排卵数均显著高于LE组(P<0.05)。LE联合HMG组的临床妊娠率(26.62%vs. 16.67%)和活产率(24.03%vs. 15.05%)显著高于LE组(P<0.05);两组间的出生孕周、胎儿身长、出生体重等围产期结局均无显著差异(P>0.05)。多因素Logistic分析显示，排卵数是临床妊娠率[OR=1.707,95%CI(1.089,2.676),P=0.020]和活产率[OR=1.666,95%CI(1.053,2.636),P=0.029]的独立影响因素。结论 不明原因性不孕患者AIH助孕使用LE联合HMG促排卵治疗可提高临床妊娠率及活产率，可能与增加排卵数有关，但对围产结局无显著影响。
Abstract：Objective:To compare the effects of letrozole(LE) combined with HMG and LE alone on pregnancy and perinatal outcomes in patients with unexplained infertility during artificial insemination by husband(AIH),and to provide evidence for selecting the best strategy for ovulation induction.Methods:A retrospective study was conducted to analyze 340 cycles of 340 patients with unexplained infertility who underwent AIH for the first time at Department of Reproductive Medicine of Luoyang Maternal and Child Health Hospital from January 2016 to December 2022. Patients were divided into two groups as LE combined with HMG group(n=154) and LE alone group(n=186) according to the strategy of ovulation induction. Clinical characteristics and outcomes of ovulation induction were compared between the two groups. A multivariate logistic regression analysis was used to evaluate the impact factors of clinical pregnancy rate and live birth rate.Results:There were no significant differences in age, infertility years, antral follicle count, follicle diameter, endometrium thickness on HCG day and male sperm concentration in AIH between the two groups(P>0.05),while there were significant differences in body mass index(BMI),the duration of ovulation induction and the number of ovulation between the two groups(P<0.05). The clinical pregnancy rate(26.62% vs. 16.67%)and live birth rate(24.03% vs. 15.05%)in LE combined with HMG were significantly higher than those in LE group(P<0.05),and there were no significant differences in perinatal outcomes such as gestational weeks, birth height and birth weight between the two groups(P>0.05). The multivariate logistic analysis results showed that the number of ovulation was an independent factor of clinical pregnancy rate[OR=1.707,95%CI(1.089,2.676),P=0.020] and live birth rate[OR=1.666,95%CI(1.053,2.636),P=0.029].Conclusions:LE combined with HMG can improve the clinical pregnancy rate and live birth rate of patients with unexplained infertility in AIH cycles, which may be related to the increase of ovulation number, but it has no significant impact on perinatal outcomes.
[1] Guideline Group on Unexplained Infertility,Romualdi D,Ata B,et al.Evidence-based guideline:unexplained infertility[J].Hum Reprod,2023,38:1881-1890.
[2] 杨一华，黄国宁，孙海翔，等.不明原因不孕症诊断与治疗中国专家共识[J].生殖医学杂志，2019,28:984-992.
[3] Practice Committee of the American Society for Reproductive Medicine.Electronic address:asrm@asrm.org;Practice Committee of the American Society for Reproductive Medicine.Evidence-based treatments for couples with unexplained infertility:a guideline[J].Fertil Steril,2020,113:305-322.
[4] Farquhar CM,Liu E,Armstrong S,et al.Intrauterine insemination with ovarian stimulation versus expectant management for unexplained infertility(TUI):a pragmatic,open-label,randomised,controlled,two-centre trial[J].Lancet,2018,391:441-450.
[5] Healey S,Tan SL,Tulandi T,et al.Effects of letrozole on superovulation with gonadotropins in women undergoing intrauterine insemination[J].Fertil Steril,2003,80:1325-1329.
[6] Wessel JA,Danhof NA,van Eekelen R,et al.Ovarian stimulation strategies for intrauterine insemination in couples with unexplained infertility:a systematic review and individual participant data meta-analysis[J].Hum Reprod Update,2022,28:733-746.
[7] Liu J,Li TC,Wang J,et al.The impact of ovarian stimulation on the outcome of intrauterine insemination treatment:an analysis of 8893 cycles[J].BJOG,2016,123:70-75.
[8] Zolton Jessica R,Lindner Peter G,Terry Nancy,et al.Gonadotropins versus oral ovarian stimulation agents for unexplained infertility:a systematic review and meta-analysis[J].Fertil Steril,2020,113:417-425.
[9] Gunn DD,Bates GW.Evidence-based approach to unexplained infertility:a systematic review[J].Fertil Steril,2016,105:1566-1574.
[10] Cantineau AE,Cohlen BJ,Heineman MJ.Ovarian stimulation protocols(anti-oestrogens,gonadotrophins with and without GnRH agonists/antagonists) for intrauterine insemination(IUI) in women with subfertility[J].Cochrane Database Syst Rev,2007,(2):CD005356.
[11] Danhof NA,Wang R,van Wely M,et al.IUI for unexplained infertility-a network meta-analysis[J].Hum Reprod Update,2020,26:1-15.
[12] Danhof NA,van Wely M,Repping S,et al.Follicle stimulating hormone versus clomiphene citrate in intrauterine insemination for unexplained subfertility:a randomized controlled trial[J].Hum Reprod,2018,33:1866-1874.
[13] Luthra R,Kirma N,Jones J,Tekmal RR.Use of letrozole as a chemopreventive agent in aromatase overexpressing transgenic mice[J].J Steroid Biochem Mol Biol,2003,86:461-467.
[14] Ganesh A,Chattopadhyay R,Narendra Babu K,et al.Analysis of spindle characteristics and embryo quality in mice stimulated with letrozole using Polscope imaging[J].Fertil Steril,2010,93:1477-1481.
[15] Takeshima K,Ezoe K,Kawasaki N,et al.Perinatal outcomes and congenital anomalies associated with letrozole and natural cycles in single fresh cleaved embryo transfers:A single-center,10-year cohort study[J].F S Rep,2022,3:138-144.
[16] 倪丽莉，王菁，刁飞扬，等.不同诱导排卵方案对不明原因不孕夫妇人工授精助孕结局的影响——单中心八年2642个周期回顾性研究[J].生殖医学杂志，2021,30:1272-1279.
基本信息:
中图分类号:R714.8
引用信息:
[1]欧阳璐,袁璠.来曲唑联合人绝经期促性腺激素治疗对不明原因性不孕患者行夫精人工授精妊娠及围产结局影响的分析[J].生殖医学杂志,2024,33(12):1608-1613.
2024-12-15
2024-12-15