Ryan Ginny L, Moss Victoria, Davis William A, Sparks Amy E T, Dokras Anuja, Van Voorhis Bradley J
Division of Reproductive Endocrinology and Infertility, University of Iowa Roy J. and Lucille A. Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City 52242, USA.
J Reprod Med. 2005 Dec;50(12):943-50.
To compare the efficacy and cost-effectiveness of different induction protocols involving gonadotropins with intrauterine insemination (IUI).
We performed a retrospective chart review of 648 IUI cycles. Some patients had gonadotropin injections alone before human chorionic gonadotropin (hCG) and IUI (human menopausal gonadotropin protocol); others were given oral medications, then gonadotropins before hCG and IUI (combination protocol). Outcomes included pregnancy rates, multiple birth rates, endometrial thickness, number of ovarian follicles, injection days, ampules of gonadotropins and cost.
The combination protocol was more cost-effective. In first cycles, pregnancy rates, multiple birth rates, number of large follicles produced and cancellation rates were similar. The combination group had fewer days of injections and fewer ampules used. When all cycles were analyzed, the multiple birth rate was lower in the combination group. Comparing the different oral medications in the combination protocols, letrozole yielded higher pregnancy rates than tamoxifen or clomiphene. Multiple birth rates were similar for all oral medications.
Combination protocols are less costly and equally effective, with potentially fewer multiple births than with gonadotropins alone. Letrozole may be more effective than clomiphene and tamoxifen in a combination protocol.
比较不同促性腺激素诱导方案联合宫腔内人工授精（IUI）的疗效和成本效益。
我们对648个IUI周期进行了回顾性图表审查。一些患者在注射人绒毛膜促性腺激素（hCG）和进行IUI之前仅注射促性腺激素（人绝经期促性腺激素方案）；其他患者先服用口服药物，然后在注射hCG和进行IUI之前注射促性腺激素（联合方案）。结果包括妊娠率、多胎出生率、子宫内膜厚度、卵巢卵泡数量、注射天数、促性腺激素安瓿数量和成本。
联合方案更具成本效益。在首个周期中，妊娠率、多胎出生率、产生的大卵泡数量和取消率相似。联合组的注射天数和使用的安瓿数量较少。在分析所有周期时，联合组的多胎出生率较低。比较联合方案中不同的口服药物，来曲唑的妊娠率高于他莫昔芬或克罗米芬。所有口服药物的多胎出生率相似。
联合方案成本更低且效果相同，与单独使用促性腺激素相比，多胎出生率可能更低。在联合方案中，来曲唑可能比克罗米芬和他莫昔芬更有效。
